Pre-Registration for September 24, 2011 Keezlenutten Beginner Show
To pre-register for the September 24, 2011 beginner show, please fill out the following form for each horse/rider combination.
*Current negative Coggins form MUST be presented for each horse/pony entered*
Rider Name
Owner Name
Address
City State AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip
Phone
Person Responsible for Payment
Email address
Classes Entered
1. Baby Beginner Equitation
2. Baby Beginner Equitation
3. Baby Beginner Equitation
Leadline
4. Beginner Equitaiton
5. Beginner Equitaiton
6. Beginner Equitaiton
7 . Intermediate Equitation
8. Intermediate Equitation
9. Intermediate Equitation
10. Intermediate Equitation
11. Open Equitation
12. Open Equitation
13. Open Equitation
14. Beginner/Intermediate Pleasure
15. Beginner/Intermediate Pleasure
16. Beginner/Intermediate Pleasure
17. Open Pleasure
18. Open Pleasure
19. Open Pleasure
20. Just Starting Jumpers - cross rails
21. Just Starting Jumpers - cross rails
22. Just Starting Jumpers - cross rails
23. Just Starting Jumpers - 15" - 21"
24. Just Starting Jumpers - 15" - 21"
25. Just Starting Jumpers - 15" - 21"
Entry Fees:
Classes are $12. $10 office fee is waived by pre-registering by noon on Friday before show.
I AGREE in consideration for my participation in this competition to the following: I AGREE that I choose to participate voluntarily in the competition with my horse, as rider, driver, handler, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risk of accident , loss and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death (“harm”). I AGREE to release Keezlenutten Farm, LLC from all claims for money, damages or otherwise for any “harm” to me or my horse for any “harm” caused by me or my horse to others, even if the “harm” resulted, directly or indirectly, from the negligence of Keezlenutten Farm, LLC and the Competition. I AGREE to indemnify (that is, to pay any losses, damages or costs incurred by) Keezlenutten Farm, LLC and the Competition and to hold them harmless with respect to claims for “harm” to me or my horse, and for claims made by others for any “harm” caused by me or my horse at the competition. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of the Release on the Child’s behalf. I AGREE that Keezlenutten Farm, LLC and the Competition as used above includes all of their officials, officers, directors, employees, agents, personnel, volunteers and affiliated organizations.
