2003 Pan American Championship
100 Miles CEI****

FEI Ride Entry Form



  • Entry Fee: $US600.00
    Please read the attached information, especially the sections on rider and horse documents and equine flu requirements. You may print and complete this form and mail it with your payment to:

    Don't forget to sign the USA Equestrian release!

    Rider name________________________________________________________
    Rider USA Equestrian #______________________________________________
    Nationality_________________________________________________________
    (Non-US must have letter of permission sent to management from your National Federation - USA Equestrian)
    Horse name_________________________________________________________
    Horse USA Equestrian #______________________________________________
    Horse FEI passport number____________________________________________
    (Optional)
    Horse country of birth________________________________________________
    Horse age__________________________________________________________
    Foaled_____________________________________________________________
    Horse breed________________________________________________________
    Horse gender_______________________________________________________
    Horse owner________________________________________________________
    (If different from rider, owner must also sign release/waiver on reverse side)
    Owner address______________________________________________________

    Equine influenza vaccinations:
    (See equine influenza vaccination requirements)
    Attach statement from vet verifying these vaccination dates:
    First shot:____________________________
    Second shot:__________________________
    Annual booster dates:___________________
    Coggins date:_________________________
    (Attach copy of coggins report)

    USA Equestrian Entry Agreement:

    I have read the USA Equestrian ("the Federation") Entry Agreement (Article 1502.4) as printed in the Prize List for this Competition and agree to all of its provisions. I understand and agree that by entering this Competition, I am subject to Federation Rules, the Prize List, and local rules of the competition. I agree to waive the right to the use of my photos at the competition, and agree that any actions against the Federation must be brought in New York State.

    USA Equestrian Release, Assumption of Risk, Waiver and Indemnification
    This document waives important legal rights. Read it carefully before signing.

    I AGREE in consideration for my participation in this Competition [insert name] to the following:

  • I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death ("Harm").
  • I AGREE to release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm caused by me or my horse to others, even if the Harm resulted, directly or indirectly, from the negligence of the Federation or the Competition.
  • I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition.
  • I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse at the Competition.
  • I have read the Federation Rules about protective equipment, including Articles 318 and 1712, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries.
  • If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf.
  • I AGREE that "the Federation" and "Competition" as used above includes all of their officials, officers, directors, employees, agents, personnel, volunteers and affiliated organizations.

    BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank.

    Rider/ Driver/ Handler (mandatory) Signature: ___________________
    Print Name: _______________

    Owner/ Agent (mandatory) Signature: ___________________
    Print Name: ___________________

    Trainer (Mandatory) Signature: ___________________
    Print Name: ___________________

    Coach (if applicable) Signature: ___________________
    Print Name: ___________________

    Parent/ Guardian Signature (Required if rider/ driver/ handler is a minor) ___________________
    Print Parent/ Guardian Name: ___________________

    Is Rider/ Driver/ Vaulter a U. S. Citizen: ___Yes ___No

    Below this line is for management use only:
    Horse rider competition number:_______________________________
    Passport #_______________ or Coggins report: yes no
    Collected date: ___________
    Returned date: ___________
    Initials of official_________

    Results of first examination:
    Temperature: ___________
    Pulse: _________________
    Metabolics:_____________
    Clinical signs of illness: ____________________________
    Allowed into CEI stabling area: ______________________
    Dismissed from competition: ________________________
    Date: ____________
    Examining veterinarian: ____________________________
    Initial weight of rider and tack: ______________________