WESTERN HORSE ON-LINE ENTRY FORM

MEMBERSHIP FEE: YOUTH - $ 2.00 SENIOR - $10.00

I hereby certify that every horse/pony and rider is eligible as entered and agree for myself and any of my representatives to be bound by the rules of this show, and I hereby release the Gloucester Agricultural Society, the Rideau-Carleton Entertainment Centre and the City of Ottawa from all damages of any nature which may be occasioned to the above animal(s), or occasioned by the negligence of any person or person in charge.

EXHIBITOR'S NAME:
EXHIBITOR'S SIGNATURE: (REQUIRED AT SHOW)

EXHIBITOR'S ADDRESS:

EXHIBITOR'S PHONE NUMBER:
SIGNATURE OF PARENT OR GUARDIAN OF JUNIOR: (REQUIRED AT SHOW)