| Exhibitor Name: ________________________________________ Show Date:__________________________ |
| Address: ______________________________ City: __________________ State: _________ Zip: __________ |
| Home Phone: ___________________________ Cell or Work: _______________________________________ |
| E-mail: ______________________________ |
Division: |
12/under |
13 - 17 |
18/over Am |
Professional |
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| |
| Horse's Name: ____________________________________ |
(circle one) |
2 Gait |
3 Gait |
|
| |
| Nominated? |
_____ Yes _____ No |
Trainer's Name: _________________________________________ |
|
| |
Release of Liability |
| In consideration of the acceptance of the foregoing entry, it is understood and agreed that I/we are aware of the risks and exposures to personal injury involved through horsemanship activities, and I hereby release the Los Vallecitos Riders, and the officers and members thereof, and each of them, from all and every claim for damages which may accrue to me or horse at any time hereafter, in favor of myself, my heirs, representatives of dependents, against said Association, it's officers and members, or any of them, by reason of any injury, loss or damage which may be suffered by me or them because of any matter, thing, or condition, negligence, or default whatsoever, and I hereby assume and accept the full risk and danger of any hurt , injury or damage which may occur through or by reason of any matter, thing, condition, negligence, or default, and/or any person or persons whatsoever, in the exhibitions, sports, contests and parades, or any of them, held or given by or under the direction of said Association. |
| _________________________________________________________ |
___________________ |
| Signature of exhibitor or parent/guardian if exhibitor is a minor REQUIRED! |
Date |
| |
| _________________________________________________________ |
| Print Name |
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