Current date is: 2012-10-04 Late Fee applied after: 2012-07-29

Entry Form ONLINE Payment for August 5, 2012 CT

  • Please submit one for each entry per horse/rider combination.
  • Please pay using the "make payment now" link at the bottom; otherwise submit without payment and mail your check as per instructions below.
  • Check the website for entry status. Times will be available the Wednesday before the show.
  • Shaded fields with * are required fields.
  • You will receive a copy of the your entry to the email you provide.

Owner/Rider Information

Rider First Name *:
Rider Last Name *:
Rider Address:
Rider Phone *:
Email Address *: 
(only used for CT communications)
Confirm Email *: 

Rider Status

This helps us with placing entrants into a division and designation for special awards. Check all that apply.
Eligibility limited to horse and/or rider not having shown at a level above the level being entered.

Junior  (18 & Under)


Active Pony Club Member:     

Horse Info

Horse's Show Name 

Coggins Ascession Number:      /   Date Drawn: 

You can upload your coggins at the end or mail or email it separately.

Combined Test Divisions

Level Not
Entry Fee $60
PC Entry Fee $50

Baby Novice

Beginner Novice




Eligibility for CT Divisions (check one or both if you are eligible)

Horse  Rider

Dressage Schooling Rounds:

$30 each. (Second of any duplicate tests to be ridden HC). Dressage only tests ridden instead of CT, or in addition to CT dressage if CT division is selected.

Level None One Test at This Level Two Tests at This Level
(USEF 2011 Introductory Test B):

Beginner Novice:
(USEF 2010 Beginner Novice Test B):

(USEF 2010 Novice Test B):

(USEF 2010 Training Test B):

(USEF 2010 Prelimary Test B):

Stadium Jumping Schooling Rounds

$20 each round, unjudged only. ("Two Rounds" means you will do 2 rounds at that level)

NOTE:  If competing in CT, then jumping schooling rounds to be at CT level or higher



One Round

Two Rounds

Baby Novice (2'0" max)

Beginner Novice (2'6" max)

Novice (2'11" max)

Training (3'3" max)

Prelimary (3'7" max)


Electronic Signature:

I understand that this is a high risk sport and I am participating at my own risk. I hereby assume this risk and further hereby release and hold harmless Middleburg Orange County Pony Club, its officers, members, volunteers, show committee members and volunteers, and judges, as well as the owners, leasers and/or managers of Glenwood Park from all liability for negligence resulting in accident, damage, injury, or illness to myself and to my property, including the horse or horses which I will be participating with at this event.

*Check this box to indicate your agreement of the Electronic Signature and Hold Harmless agreement above,
then type your name in the appropriate box below:

  Parent or Guardian of junior (age 18 and under) must check here

Electronic Signature of Parent or Guardian:   

Electronic Signature of Rider:    

Paying For::  

Submit & Pay

Late Registration Fee:  $  (automatically assigned after July 29, 2012)


Total Amount Due: $ (calculated automatically)

Additional Notes:

TIP:  If your form does not submit, please scroll up and be sure you have all the shaded required fields filled out.

You will have a chance to confirm and submit on the next page.