Entry Form: Please complete all fields (or click here for PDF)

Event Name   Date of Event   Horse's Name Rider's First Name Last Name Email Address Street Address: Suburb City Postcode Telephone Age (if under 16) 15 14 13 12 11 10 9 8 7 6 5 4 Do you wear a medical band? Yes   No If not, what is your blood type? Are you allergic to anything? Yes   No If yes, What?      Do you have any medical conditions we should be aware of in the event of an accident? Yes   No If yes, What?      Would you like to be added to the GraceBrook mailing list? Yes   No  Already Listed Agreement:: I have read and understood the General Rules and Information and I agree to: Wear a helmet when mounted conforming to current NZ safety standards Wear back protection when jumping Report any injuries to self/horse to management Report any damage to equipment to management Disclaimer I also understand that GraceBrook Equestrian Training Centre and its staff take no responsibility for any damage to or loss of personal property, accidents or injury to riders or horses and that I ride at my own risk. Name of Parent/Guardian   Please note: For riders under 16 years old the parent or guardian will be required to sign a release form on the day. If you have any questions regarding this entry, please telephone Debra on (03)314-7076, or use our Enquiry Form PRIVACY POLICY:   We respect your privacy and will not sell, share or disclose your name or details to any third party.  We will amend or delete your records upon request.