BACK # NAME OF SHOW: DATE OF SHOW

PENNSYLVANIA PINTO HORSE CLUB SHOW

Saturday, July 13, 2019
OWNER OR LESSEE NAME (Exactly as shown on Registration papers): OWNER PtHA MEMB# OR LEASE ID# PHONE #

ADDRESS: CITY: STATE: ZIP CODE:

NAME OF HORSE: REGISTRATION NUMBER: FOALING DATE:

CIRCLE ONE OF EACH

CLASSIFICATION: SEX: PATTERN: TYPE:
HORSE PONY MINIATURE MARE STALLION GELDING OVERO TOBIANO SOLID STOCK HUNTER PLEASURE SADDLE

ONLY ONE HORSE AND AMATEUR OR YOUTH EXHIBITOR PER FORM

AMATEUR/NOVICE EXHIBITOR'S NAME PtHA #:

R

ADDRESS: CITY: STATE: ZIP CODE:

U

RELATIONSHIP TO OWNER: DATE OF BIRTH: PHONE:

TE
A
M

AMATEUR CLASS#
A

NOVICE CLASS #

ONLY ONE HORSE AND AMATEUR OR YOUTH EXHIBITOR PER FORM

YOUTH EXHIBITOR'S NAME PtHA #:

ADDRESS: CITY: STATE: ZIP CODE:

TH

RELATIONSHIP TO OWNER:
U

DATE OF BIRTH: PHONE:

O
Y

YOUTH CLASS #

SEPARATE BACK NUMBERS ARE NOT NECESSARY FOR OPEN CLASSES

OPEN EXHIBITOR NAME PtHA# PHONE:

ADDRESS: CITY: STATE: ZIP CODE:

N
PE
O

OPEN CLASS #

Reset Form
 PAY AS YOU SHOW OR LEAVE A BLANK CHECK AT THE SECRETARY STAND
TRAIL HORSE (Check ONE)
ENGLISH WESTERN
AMT./AMT. MINI/PONY CLASSES ENTRY FEES: @$16/CLASS $=

AMT./AMT. MINI/PONY DAY FEE = $100 .

NOV. AMT. SHOWMANSHIP (Check ONE) NOVICE AMTATEUR ENTRY FEES: @$16/CLASS=
ENGLISH WESTERN
NOVICE AMATEUR DAY FEE = $100 .

OPEN ENTRY FEES: $16/CLASS=

OPEN CLASS DAY FEE = $100 .

OPEN MINIATURE: @$16/CLASS=

$50 fee for returned checks
OPEN MINIATURE CLASS DAY FEE = $100 .

SOLID REGISTRY ENTRY FEES: @$12/CLASS=

By the act of entering this show, Owners, Lessees and Exhibitors
agree that the PtHA, the PA Pinto Horse Club, Twin Brooks Show YOUTH ENTRY FEES: @$16/CLASS=
Assoc. and the Show Committee will not be held responsible for any
loss, death, injury, damage, or debts in connection with this show. YOUTH CLASS DAY FEE = $100 .
Show committee reserves the right to expel any person from the
show grounds without refund of entry fees for cruelty to animals or
PtHA CLASS FEE: TOTAL# OF PtHA CLASSES
excessive un-sportsman like conduct.
ENTERED: X$1.00=
**Liability Disclaimer must be signed before schooling or riding
any horse, pony, or miniature horse. ** Youth $10/Single $20/Family $25: PA PINTO MEMBERSHIP=

GROUNDS FEE $10.00= $10.00

Signature of Owner or Exhibitor/Rider/Agent
(Parent or Guardian if under 18) PtHA FEES $5.00/JUDGE= $5.00

Make checks Payable to

PA Pinto Horse Club PtHA MEMBERSHIP FEES=

PAID BY: CASH CHECK # OTHER PtHA FEES=

TOTAL AMOUNT DUE=

Click to PRINT