Loose Jumping Application Form
For 3 & 4 year old fillies
Please see below Terms and Conditions. HSI Loose Jumping is supported by the DAFM National Breeding services
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Applicant Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
IBAN
*
This will be used to pay any prize monies owed on receipt of the relevant data related to the scheme/ initiative.
Bank Account Name
*
Must match the account name to the IBAN provided
Address
*
Address Line 1
Address Line 2
Address Line 3
County
Eircode
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Horse Details
Filly Name
*
Filly UELN
*
Filly Studbook
*
Connemara Pony
Irish Clydesdale Horse Studbook
Irish Sport Horse
Irish Draught
Irish Sports Pony
Irish Piebald & Skewbald (IPSA - LHI)
Irish Standardbred Trotter/Pacer
Kerry Bog Pony
Warmblood Studbook of Ireland
Welsh Pony & Cob Studbook of Ireland
Other
Year of Birth
*
2022
2021
Dam Name
*
Sire Name
*
Damsire
*
Breeder
*
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Venue
My filly is a
*
Pony
Horse
I agree that my filly meets the pony height criteria
*
Yes
No
Height of Pony
*
128 cm
138 cm
148 cm
Venue
*
Creagh 2nd September
Venue
*
JAG Equestrian 14th August
Kernans EC, 21st August
Tubberbride EC, 26th August
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Please provide signature
Signature
Submit
Should be Empty: