Untitled Document

1 Full Registered Name of Your Horse: _______________________________________________

2 Registered AQHA ID # Of Your Horse: _______________________________________________

3 Barn Name of Your Horse: _________________________________________________________

4 Name of Donor: __________________________________________________________________

(If Owner and donor are not the same please have all owners read and sign this form)

5 Address: _________________________________________________________________________

6 Home Phone: ____________________________________________________________________

7 Cell Phone: ______________________________________________________________________

8 Emergency Contact: ______________________________________________________________

9 E-mail Address: __________________________________________________________________

10 Please place a check mark in the box next to the events that your horse is capable of competing in:

11 Medical history of the horse. (Please state any physical condition which may jeopardize the well-being

of yourhorse while involved in this event): _________________________________________________________

________________________________________________________________________________________________

a)How long have you owned and ridden this horse?____________________________________

b)Are you the person who rides and cares for this horse on a regul(If not, please confirm the information with the rider and stable)

________________________________________________________________________________________

d) Horse's training background and experience in and out of the show ring? (Horses with extensive show experience should give a
condensed version confirming the type and years of show experience.)

________________________________________________________________________________________________________________________

e)Where time and conditions permit, reasonable attempts will be made to contact the owner for treatment discussion and decisions.
Where in the discretion of the veterinarian, time or the horse's condition, do not allow for contact with the owner then the Undersigned,
as owner, consents to the treatment of the horse by a qualified veterinarian as provided by the YWC (Ilderton Equine Services - on call)
and releasesthe YWC and that veterinarian from any liability arising from the treatment provided by that veterinarian to the horse as
deemed necessary, up to and including euthanasia.The Undersigned, as owner, is responsible for all veterinary costs incurred.

12Please provide the daily feed schedule , amount and type of feed that this horse will be consuming prior to arrival at the YWC

______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

13 If you provide a daily supplement to your horse and you would like for the horse care team at the AQHA Youth World Cup to provide
said supplements, please provide a detailed listing of what is administered daily. Further to the list, you must supply us individually
packaged and labeled doses for each day. (ex. Zip lock bags or plastic containers.) ____________________________________________________

________________________________________________________________________________________________________________________________

14 Nutrena Feed and quality oats will be supplied to all of the horses of YWC. If you require a special diet, this too must be supplied and clearly
labeled for your horse. (See sec 2)

15 What kind of warm up does your horse require? _____________________________________________________________________________________

____________________________________________________________________________________________________________________________________

16 Does your horse have any bad habits? I.e.. Cinchyness or sets back when tied?(PLEASE NOTE:In order to help us care for your horse and those
who will be around him/her it is very important that we be aware of your horse's character including his/her behavior, vices,habits, fears etc.
These details could be very important so please be complete, frank and clear.) ______________________________________________________________

______________________________________________________________________________________________________________________________________

16b Is your horse comfortable with clippers? Please advise if there is any known activity or thing which your horse has feared, or avoids.

________________________________________________________________________________________________________________________________________

17 Do you ride with spurs and if so what type? _________________Do you recommend that your horses rider wear spurs or not? __________

17b In what way do you use your spurs? i.e.spur stop? _____________________________________________________________

18 Will you be able to transport your horse by Thursday July 3, 2008? (All round horses) Yes No

19 Will you be able to transport your cutting horse by Thursday July 10, 2008? Yes No 20Will you be able to transport your reining horse by
Friday July 11, 2008? Yes No

18,19,20 If you cannot transport your horse by the dates above, where can the horse be b) located to be picked up and transported to
The London Agriplex at the London Fair?

_________________________________________________________________________________________________________________________________

c) Please advise us as to the type of trailer you use and of any difficulty that may be encountered in the loading, trailering or unloading of your horse.

________________________________________________________________________________________________________________________________________

Contact Person: ________________________ Phone: __________________________Cell Phone: _____________________________

21 We would prefer if you provide all tack that your horse is accustomed to. Bridles must be supplied with the horse and we highly recommend

that you provide the horses show saddle as well. All items are catalogued upon arrival) Please list the items that you will supply and include

any special instructions: _____________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________

22 Is your horse insured? Yes No a)If so, by whom and for what coverages? ____________________________________________________________

_____________________________________________________________________________________________________________________________________

b)Please confirm that you have contacted your insurer to ensure your coverages will still apply during this event? Yes No

23 What is your policy number and emergency claim number? _________________________________________________________________________

By your signature below, you are representing to CQHA that you reasonably believeyour horse to be physically able to participate with the stated condition.
FURTHER, WHETHER OR NOT MEDICAL INFORMATION IS SUPPLIED ABOVE, YOU ASSUMERISK OF INJURY OR DEATH TO YOUR HORSE FROM DISEASE OR
OTHER DEBILITATINGPHYSICAL INJURY EVEN THOUGH CQHA MAY PROVIDE VETERINARY SERVICE AT THE EVENT SITE.

24 If you will be registering your horse or horses for sale at Youth World Cup please fill in the following: What is the full registered name of the horse for sale?

_______________________________Is the above listed horse Canadian-bred? ___________________________________________

Will you be including a copy of the registration papers with this form? _________________

Please use this space to fill out the above information for multiple horses being registered for sale by the same owner. _________________________________

___________________________________________________________________________

_________________________________________________________________________________________________________________________________________

25 Person Completing the Form (please print): ___________________________________________________________ ______________________ _____________

Signature ________________________________________________ Witness Date ___________________________ _______________________________________

Phone ________________________Fax________________________Cell Phone ________________________E-mail Address _______________________________

Please return to Youth World Cup: Patti Carter or fax to Charlene Hancock at 519-928-3128

Section 2 AQHA Youth World Cup Nutritional Requirements Form YWC will supply the following: Nutrena - Complete Feed Oats Good Quality Hay If the
above choices are not suitable for you please tick off the "Supply Your Own" box below and provide us with feed labeled specially for your horse.
We will also require that you give full feeding instructions on the space left below. Supply Your OwnSpecial Feed Instructions: _________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

At the request of Canadian Quarter Horse Association (CQHA), a Canadian non-profit corporation, the Undersigned has volunteered to furnish an American
Quarter Horse or Horses, suitable to perform with youth exhibitors in equine events at the 2008 International Youth World Cup, to be held in London Ontario
Canada July 6 , 2008 to July 13, 2008. (All-around horses to begin arriving on Thursday July 3, 2008 for assessment). As a condition of such participation, the
Undersigned acknowledges that:1. Transportation of the Undersigned, and the horse or horses to and from the site of the event is the responsibility of the
Undersigned, (including horses picked up for transportation)and also the Undersigned assumes the risk of personal injury or property damage caused by
vehicle accident or otherwise to, from and while at the event site. event site.

2. The Undersigned warrants and represents that both as to training and disposition, the horse or horses furnished are suitable to safely perform with a
contestant in the assigned equine events, and if tack is to be furnished, the condition of the equipment and tack is sufficient to safely allow a contestant to
compete with the horse. 3. Every owner accepts the facility and grounds on an "as is" basis, including, but not limited to, the arena, stalls and alleyways,
where the show is being conducted, agreeing to indemnify andhold harmless AQHA, CQHA, its representatives, agents, or employees, from any and all
liability for personal injury to the Undersigned, injury to the horse, or property damage or loss of furnished tack, whenever or however arising, from the
participation of the Undersigned's horse in this show.

Printed Name of Donor________________________________________Signature ________________________________________Date ____________________________

Printed Name of Owner________________________________________Signature ________________________________________Date ____________________________
If different from owner