1. Horses Registerd Name for Equistat
Address: ______________________
City: ______________ State: _____
Zip Code: _____ Phone: __________
BBR#: __________WPRA#:_________
SS#: __________________(for tax purposes)
PLEASE WRITE LEGIBLY! THX 
2018 Entry Form
December 1st
Horses Registerd Name for Equistat
$45 Open
$35 Youth
$20 Adult
$20 Senior
$45 Derby
5D Open
4D Youth 18 and Under
Office Fee Included 80% Payback
3D Adult
3D Senior 49 and Over
Carry Over Incentives Only 80% Payback
2D Derby (See Rules)
BUYBACKS AVAILABLE
FOR ANY REASON ALL RUNS COUNT
Saturday
Add Columns for Saturday
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Entries
Saturday
10:30___ 11___ 11:30___ 12___ 12:30___ =_____+
Exh’s Saturday
$5 Exhibitions
Stalls $25 daily x __= ___ RV $35 nightly x __=___ Total _____ Other _____
Stalls/RV’s & Other Fees
Total
______________________________________ __________________
Signature (Guardian if under 18 yrs Date
Under Texas Law, (Chapter 87, Civil Practice and Liberties Code), an equine professional is not liable for injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities. In submitting my entry, I herby release the show coordinators, or agent of the same, form any claim or right for damages, which may occur to me or my horse at this show or transit.