Fun Day Entry Form

Fun Day Date: Sunday 16th February 2020

Entries are Open. Entries close midnight Monday 3rd February.

There may be spots available in some classes that are offered at the Fun Day after the closing date – please email Shibumi Equestrian Centre (equestriancentre@shibumi.net.au) directly to find out what classes may be available.

All riders/ parents/ guardians must read our Shibumi FUN DAY NOTICE  before filling out the below entry form.

Risk Warning, Waiver & Indemnity Forms:

RWW – Adults NSW – Riders & Drivers

RWW – Children NSW – Riders and Drivers

Our bank details are:

Account Name: Shibumi Equestrian Centre Pty Ltd
BANK: ANZ
BSB: 012 013
Account number: 288 666 767

N.B. Organisers reserve the right to close classes if they become full before closing date. To avoid disappointment please enter early as places in each class are limited.
If entry fee does not accompany the entry – with name of rider as reference and a copy of the
transfer emailed thru – the entry will not be considered valid and the rider’s name will not appear on the draw.

$22 per CLASS + $5.50 ground levy for horses entering Shibumi

Please note that entries must be paid within 48 hours of entering.  Failure to make payment within this time period may result in your entry being cancelled.
An invoice will not be automatically sent to you – if you require an invoice please email Sheryl on equestriancentre@shibumi.net.au

If you are human, leave this field blank.

February 2020 Fun Day Entry

Contact & Payment Details

Entries are not finalized until your payment has been made in full and confirmation (including receipt of payment) has been sent via email to equestriancentre@shibumi.net.au. This must be completed within 48 hours of entering. No Exceptions. Failure to make payment within this timeframe may result in your entry being cancelled.

First Name *

Surname *

Mobile No. *

Physical address of rider
*

CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabwe

City

Zip code

Postal address of rider (only required if different to physical address)

CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabwe

City

Zip code

Your email address *

Please select your method of payment *

Existing 'Shibumi' Account (for Shibumi Agistors/Pupils only)Bank Transfer (Preferred) Shibumi Equestrian Centre Pty LtdCheque or Money OrderIMPORTANT: As stated above entries will not be accepted until payment has been received. Please email receipt of payment to equestriancentre@shibumi.net.au with rider's name as reference.

*

I understand that payment must be made (and receipt of payment emailed) within 48 hours of entering or my entry may be cancelled.

*

I understand that entries that are NOT PAID at the time of the entry being submitted WILL NOT be included on the draw.

*

I understand No refunds after the closing date unless a vet or doctors certificate is presented and that an administration fee will be withheld

Important Information

Risk Warning,Waiver & Indemnity *

YES, I have read, accept and agree to adhere to the ‘Risk Warning,Waiver & Indemnity’ document, downloadable at the top of this page.

Photo Release *

By participating in equestrian activities at Shibumi Equestrian Centre you are consenting to you or your child/children being photographed or filmed. Shibumi Equestrian Centre may use these images for promotional use.

This promotional use includes but is not limited to the use of such images on the Shibumi website and any sponsors websites, marketing material and in all forms of media including social media. I understand photos in which I or my child/children appear may be passed to Shibumi Equestrian Centre sponsors who may also use these images for the purpose of promoting their products.

Junior Riders

Parent/Guardian's name (If under 18 yrs)

Parent/Guardian's Mobile #

Age Rider 1 (if under 18 yrs)

Age Rider 2 (if under 18 yrs)

Emergency Contact Details

Name of Next of Kin (In case of emergency) *

Next of Kin - Phone # (mobile preferred) *

Entry details for rider and/or horse 1

$22 per class + $5.50 Ground Levy for horses entering Shibumi Please note that you may enter more than one rider or horse by using the below fields. If you are entering more than 2 horses or riders you will have to fill out another form.

Rider Name (Rider 1) *

Horse Name (Horse 1) *

Registered Name of Horse (Horse 1) *

Owners Name (Horse 1) *

1st CLASS (1) *

NOT ENTERING ANY MORE CLASSESJ 25J 45J 65J 80J 95J 105D1 - PREPARATORY E (2015)D2 - PRELIMINARY 1B (2019)D3 - NOVICE 2A (2019)D4 - Select Your own Test

2nd CLASS (1)

NOT ENTERING ANY MORE CLASSESJ 25J 45J 65J 80J 95J 105D1 - PREPARATORY E (2015)D2 - PRELIMINARY 1B (2019)D3 - NOVICE 2A (2019)D4 - Select Your own Test

3rd CLASS (1)

NOT ENTERING ANY MORE CLASSESJ 25J 45J 65J 80J 95J 105D1 - PREPARATORY E (2015)D2 - PRELIMINARY 1B (2019)D3 - NOVICE 2A (2019)D4 - Select Your own Test

4th CLASS (1)

NOT ENTERING ANY MORE CLASSESJ 25J 45J 65J 80J 95J 105D1 - PREPARATORY E (2015)D2 - PRELIMINARY 1B (2019)D3 - NOVICE 2A (2019)D4 - Select Your own Test

Please specify Test here if you chose 'D4 - Select your own Test' for any of your tests above

Please specify your tests here (so that we can prepare tests for judges and class draw)

Entry details for rider and/or horse 2

$22 per class + $5.50 Ground Levy for horses entering Shibumi

Ride Name (Rider 2)

Horse Name (Horse 2)

Registered Name of Horse (Horse 2)

Owners Name (Horse 2)

1st CLASS (2)

NOT ENTERING ANY MORE CLASSESJ 25J 45J 65J 80J 95J 105D1 - PREPARATORY E (2015)D2 - PRELIMINARY 1B (2019)D3 - NOVICE 2A (2019)D4 - Choose your own Test

2nd CLASS (2)

NOT ENTERING ANY MORE CLASSESJ 25J 45J 65J 80J 95J 105D1 - PREPARATORY E (2015)D2 - PRELIMINARY 1B (2019)D3 - NOVICE 2A (2019)D4 - Choose your own Test

3rd CLASS (2)

NOT ENTERING ANY MORE CLASSESJ 25J 45J 65J 80J 95J 105D1 - PREPARATORY E (2015)D2 - PRELIMINARY 1B (2019)D3 - NOVICE 2A (2019)

4th CLASS (2)

NOT ENTERING ANY MORE CLASSESJ 25J 45J 65J 85J 95J 105D1 - PREPARATORY E (2015)D2 - PRELIMINARY 1B (2019)D3 - NOVICE 2A (2019)D4 - Choose your own Test

Please specify Test here if you chose 'D4 - Select your own Test' for any of your tests above

Please specify your tests here (so that we can prepare tests for judges and class draw)

Biosecurity Details (Horse 1)

PIC Number (Horse 1)

A property identification code or PIC is a unique identifier for land used for keeping livestock. PICs are assigned to individual properties and allocated by Livestock Health and Pest Authorities (LHPA).

Microchip number (Horse 1)

Microchip number or other unique identifier

Name of person usually in charge of horse (if different to rider) (Horse 1)

Persons Phone Number (Horse 1)

Physical address of horse if different from riders address (Horse 1)

Physical address where horse is usually kept i.e. agistment property

Biosecurity Section (Horse 2)

PIC Number (Horse 2)

A property identification code or PIC is a unique identifier for land used for keeping livestock. PICs are assigned to individual properties and allocated by Livestock Health and Pest Authorities (LHPA).

Microchip number (Horse 2)

Microchip number or other unique identifier

Name of person usually in charge of horse (if different to rider) (Horse 2)

Physical address where horse is usually kept i.e. agistment property

Persons Phone Number (Horse 2)

Physical address of horse if different from riders address (Horse 2)

Physical address where horse is usually kept i.e. agistment property

Other Information

Are you leading a child at the Fun Day?

Please write name of child you are leading. (so that we can allow sufficient time in the draw for you to lead and ride)

How did you hear about us? *

Facebook

Friend/Family

Search Engine like \'Google\' or \'Yahoo\'

Other

Are you a member of a club?

Please list here, e.g EFA, Moss Vale Pony Club, Bowral Dressage etc

Do you have any special dietary requests?

e.g gluten free lunch

Do you have any special needs for you or your horse?

(If none put 'NO') i.e. late start time, child in other classes to consider with draw times, horse that needs stabling etc.)

Are you or any family/friends willing to volunteer some time on the day?

please state the times you are able to help. ie. 8 - 10am, 1/2 day etc. (If no put 'NO')

Would you like to receive informaton about upcoming events at Shibumi?

Yes please, add me to your mailing list

No Thanks.

Classes are Full

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The classes you have selected are already full. Unfortunately your entry cannot be accepted.

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Submit your entry