CALIFORNIA GYMKHANA ASSOCIATION
District 9, Redwood Riders, Boulder Creek, CA.
Web Site: www.CGADistrict9.com
District 9 Rider #_________/ New
CGA# _____________ Expiration Date: ______________
Show Date: _________
Are you a current CGA member? Yes____ No_____ NOTE: CGA membership is a requirement to participate in this horse show. IF YOU ARE NOT A MEMBER, the show secretary will provide you with a membership form.
Rider Name_______________________________________
Mount Name_____________________________________
Address:_________________________________________
Zip_______________
Phone #: ( __________ ) ______-____________

Birthdate _____________________
Circle one: HORSE PONY
City:________________________________

Email Address:________________________________
 
Would you like to receive information via snail mail rather than email? Yes No
MARK THE EVENTS YOU WANT AS:
R (Regular) P (Points only) T (Time only) S (Set-up)
 
DIVISION (Circle One)
Open Pony FC (10/Under) FC (11/over)
A AA AAA AAA+
___ All Today's Events (or mark select events below)
___ Barrels ___ Poles II
___ Birangle ___ Quadrangle
___ Fig 8 Flags ___ Speed Ball
___ Fig 8 Stake ___ Speed Barrels
___ Hurry Scurry (no Leadline) ___ Single Stake
___ Keyhole ___ Big T
___ Poles I
FINANCIAL SUMMARY
Events:
All Day: (see event list for cost) $____________
Regular _____ x $4.75 $____________
Points _____ x $4.00 $____________
Set Up/Time _____ x $3.25 $____________
Mystery Jackpot 1 x $5.00 $____________
Run for Fun ($5) $____________
Ground Fee ($5) $____5.00_____
RELEASE OF LIABILITY
The California Gymkhana Association Inc., and cosponsoring organization, if any, will not be responsible for any accident that may occur to be caused by any horse competing at the show, or for any article of any kind or nature that may be lost or destroyed or in any way damaged. Each competitor will be responsible for any injury that may be occasioned to any person or animal or damage to any property while on the grounds by any horse owned, or in his custody, or control, and shall indemnify and hold harmless the California Gymkhana Association and Redwood Riders, their officials and directors individually and collectively, and cosponsoring organization, clubs, and arena owners, if any, from and against all charges and expenses of every kind and nature whatsoever arising out of which may be incurred by reason of any accident, injury, or damage to person or property caused by the ownership, competition or custody or control of any animal competition. Presentation of first signed entry form and/or membership application shall be deemed acceptance of this release throughout the entire show season for any subsequent CGA sanctioned function in which you or your child/children may participate. CGA requests that its members wear approved safety helmets.
In signing this release, please bear in mind that gymkhana is a contest of speed, that there is a certain element of danger involved, and that you will be riding at your own risk. All riders under the age of 18 MUST wear an approved helmet at all times, in or out of the arena. Adults who choose not to wear a safety helmet accept full responsibility for any injury which may result from that act when riding in any CGA sanctioned show. Signing this release also releases CGA and Redwood Riders of all liability for any injury which may occur from not wearing a helmet.
In addition to agreeing to the waiver at the above, I certify that I am either an Individual or Family Member of the California Gymkhana Association.
Signature of Applicant (Required):

_____________________________________________
(Parent or Guardian if under 18 years of age)
*optional award programs
District 9 Fees:
*Year End Awards ($30) $____________
CGA Fees:
State Membership: ($25/$50) $____________
*Level 1 Award ($35) $____________
*Level 2 Award ($40) $____________
*Top Rating + Level 1 ($120) $____________
*Top Rating + Level 2 ($125) $____________
*Top Rating + Level 1 & 2 ($140) $____________
*ROC + Level 1 ($120) $____________
*ROC + Level 2 ($125) $____________
TOTAL ALL: Check #_______ / Cash $____________
Initials of person accepting money ____________
 

 

 

Show Secretary's
Signature______________________________________