Parental Release

Exhibitor's Name *

Date of Birth *

Phone

Address

Apt, suite, etc.

Country

City

State

Zip code

Select Show Date *

Parent/Guardian Name

I hereby certify that every horse, pony, rider and/or driver is eligible as entered and agree for myself and my representatives to be bound by the by-laws of the Silver Heels Riding Club, Inc. (hereafter SHRC) and to abide by all regulations of the event