Entry Confirmation - Please review the following information

Horse Information
Name:	BRITISH EXIT	Height:	16.1	Birth Country:
Breed:	THOROUGHBRED	Sire:	BROKEN VOW	Year of Birth:	2014
Sex:	Gelding	Dam:	SUNNY	Breeder:	PAT PAVLISH
Color:	CHESTNUT	Dams Sire:		Passport #:

Information	Horse	Rider	Owner	Trainer	Coach
Name:		Sydney Pellerin	Sydney Pellerin	AVA KRUSCHWITZ	AVA KRUSCHWITZ
Address:		8 oak ave	8 oak ave	57 Meditation Lane	57 Meditation Lane
City/St/Zip:		Salem, NH 03079	Salem, NH 03079	ATKINSON, NH 03811	ATKINSON, NH 03811
Country:		usa	usa	usa	usa
Telephone:		8609775813	8609775813	603-819-9618	603-819-9618
E-mail:		sydneyjpellerin@gmail.com	sydneyjpellerin@gmail.com	derbytalk@yahoo.com	derbytalk@yahoo.com
Citizenship:		usa	usa
Rider Status:		Adult Amateur
	5839786	5838888	5838888	5570195	5570195
	1157180	200829	200829	224249	224249
Need Safe Sport:		No	No	No	No
Need Signature:		Yes	Yes	Yes	Yes
Need Coggins:	Yes
Need Vaccines:	No
Need Parent Signature:				No
StallGroup:

Need List

Class	Day	Class Name	Test Name	Qual/Div	Need FS Doc	Amount
7	Sunday	USDF Intro Level, Test A	USDF Introductory Level, Test A 2023	No	No	$ 30.00
8	Sunday	USDF Intro Level, Test B	USDF Introductory Level, Test B 2023	No	No	$ 30.00

Stable Fees	Rate	Quantity	Amount

Other Fees	Rate	Quantity	Amount
NHDEA Membership	$ 43.00	1	$ 43.00
Processing Fee	$ 20.00	1	$ 20.00

Payments	Amount
Paypal	$ 123.00

Class Total	Stable Fees	Other Fees	Total Fees	Payments	Amount Due
$ 60.00	$ 0.00	$ 63.00	$ 123.00	$ 123.00	$ 0.00

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

User	Date / Time	Notes
Secretary	5/31/2023 5:59:44 AM	UPLOADED: Must submit NHDEA liability form
Entrant	6/1/2023 5:15:08 AM	REJECTED: Scratch
Secretary	6/1/2023 4:26:37 PM	UPLOADED: SCRATCH 6/1
Entrant	6/1/2023 4:30:39 PM	ACCEPTED:

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