Capital Region C2 through A: Intent to Rate Form

Candidate Contact Information Name: Home Address: Home Phone: Email: Current Rating:

Pony Club: Cell Phone:

Intended Rating(s) (circle): C2

HB

C3

H/H-A

Parent Contact Information Name: Home Phone:

Email: Cell Phone:

Tell us about your plans for getting ready to rate: Would you prefer a spring, summer or fall rating date and why?

What have you done already and/or and plan to do with your club to prepare for this rating (are you teaching, taking lessons, attending clinics, etc.)? What you are doing and what you plan to do outside of your club to prepare for this rating?

Tell us about the horse you plan to use for this rating (age, level of training, strengths, weaknesses, etc.)

Capital Region C2 through A: Intent to Rate Form

If your horse was not available for the rating due to lameness, illness or is not suitable for the intended rating level, do you have a backup horse? If so could you tell us about him/her.

DC Statement As this upper level candidates DC, I certify that he/she is a member in good standing with our club. I have read the above plan and will support my candidate towards this rating. Name: Signature/Date:

Fees and Payments: For C2 Candidates: $75 Unmounted Prep Fee and $25 Mounted Prep Fee For HB Candidates: $75 Unmounted Prep Fee For H/A, B and A Candidates: Prep Fees will be determined based on the Prep/Camp/Clinic that are scheduled. Club checks are payable to Capital Region Pony Club. Send to the Regional Treasurer: Averil Nicewarner 23651 Rolling Fork Way Gaithersburg, MD 20882