Entry Confirmation - Please review the following information

Horse Information
Name:	BELLISSIMA I	Height:	15.2	Birth Country:
Breed:	IRISH SPORT HORSE	Sire:	UNKNOWN	Year of Birth:	2017
Sex:	Mare	Dam:	UNKNOWN	Breeder:
Color:	BAY	Dams Sire:		Passport #:

Information	Horse	Rider	Owner	Trainer	Coach
Name:		AVA KRUSCHWITZ	JESSICA BATCHELDER	Crystal Little	Crystal Little
Address:		57 Meditation Lane	270 Kennedy Hill Rd.	62 Meditation Ln.	62 Meditation Ln.
City/St/Zip:		ATKINSON, NH 03811	GOFFSTOWN, NH 03045-2318	Atkinson, NH 03811	Atkinson, NH 03811
Country:		usa	usa	usa	usa
Telephone:		603-819-9618	617-285-1160	603-953-4243	603-953-4243
E-mail:		derbytalk@yahoo.com	jlbatch88@gmail.com	derbytalk@yahoo.com	derbytalk@yahoo.com
Citizenship:		usa
Rider Status:		JR/YR
	5807731	5570195	5806316	4887551	4887551
	1154616	224249	239530	130908	130908
Need Safe Sport:		No	No	No	No
Need Signature:		Yes	Yes	Yes	Yes
Need Coggins:	No
Need Vaccines:	No
Need Parent Signature:				No
StallGroup:

Need List

Class	Day	Class Name	Test Name	Qual/Div	Need FS Doc	Amount
14	Sunday	USEF Training Level, Test 3	USEF Training Level, Test 3 2023	No	No	$ 30.00
16	Sunday	USEF First Level, Test 1	USEF First Level, Test 1 2023	No	No	$ 30.00

Stable Fees	Rate	Quantity	Amount

Other Fees	Rate	Quantity	Amount
Non-Member Fee (per class)	$ 15.00	1	$ 15.00
Processing Fee	$ 20.00	1	$ 20.00

Payments	Amount
Paypal	$ 95.00

Class Total	Stable Fees	Other Fees	Total Fees	Payments	Amount Due
$ 60.00	$ 0.00	$ 35.00	$ 95.00	$ 95.00	$ 0.00

Memo
Complete entries must include NHDEA waiver and 12-month coggins!

User	Date / Time	Notes
Secretary	5/31/2023 5:59:47 AM	UPLOADED: Must submit NHDEA liability form

	Please enter a message to post to the entrant. Please enter the notes for the entrant. Limited to 490 character.
Notes