Entry Confirmation - Please review the following information

Horse Information
Name:	OSheila	Height:	15	Birth Country:
Breed:	Qh morgan cross	Sire:		Year of Birth:	1995
Sex:	Mare	Dam:		Breeder:
Color:	Chestnut	Dams Sire:		Passport #:

Information	Horse	Rider	Owner	Trainer	Coach
Name:		Silas Little	Crystal Little	Crystal Little	Crystal Little
Address:		62 Meditation Lane	62 Meditation Ln.	62 Meditation Ln.	62 Meditation Ln.
City/St/Zip:		Atkinson, NH 03865	Atkinson, NH 03811	Atkinson, NH 03811	Atkinson, NH 03811
Country:		usa	usa	usa	usa
Telephone:		603-953-4243	603-953-4243	603-953-4243	603-953-4243
E-mail:		Atkinsonridingacademynh@gmail.com	derbytalk@yahoo.com	derbytalk@yahoo.com	derbytalk@yahoo.com
Citizenship:		usa
Rider Status:		JR/YR
			4887551	4887551	4887551
			130908	130908	130908
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
1	Sunday	Leadline Dressage Seat Equitation	USEF Dressage Seat Equitation	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	$ 65.00

Class Total	Stable Fees	Other Fees	Total Fees	Payments	Amount Due
$ 30.00	$ 0.00	$ 35.00	$ 65.00	$ 65.00	$ 0.00

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

User	Date / Time	Notes
Secretary	5/31/2023 5:59:48 AM	UPLOADED: Must submit NHDEA liability form
Entrant	5/31/2023 6:26:43 AM	ACCEPTED:

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