Maine Benefit Horse & Pony Show
Youth All Game Show
May 19th. 2012
Please Only one Form per- horse /pony and rider please
Horse or Pony Name : ____________________________________________________
Rider :_______________________ Phone :_____________
Mailing Address: ________________________________________________________
Division (circle one) Lead Line (6 and under) W/t (10 and under) Youth (11 to 13 ) Jr.. ( 14 to 17 )
Class #'s entered : ___ ,___ ,___ ,___ ,___ ,___ ,___ ,___ ,___ ,___ ,___ ,___ ,___ ,___
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Members NON Members
Day of show Day of show
For the day Fee's - $ 25.00 $ ______ For the day Fee's - $ 30.00 $ ______
Price per-class $6.00 $ ______ Price per-class $7.00 $ ______
Pre- Reg. Pre-Reg
For the day Fee's - $ 20.00 $______ For the Day Fee $ 25.00 $ ______
Price per-class - $ 5.00 $______ Price pre-class $ 6.00 $ ______
Total $______ Total $ ______
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Release and Hold Harmless
I ,the undersigned, wish to participate in the Maine Benefit Horse & Pony Club event on ___________ , 20_____. I understand that during portions of this event I will be in close peoximity to one or more horses under circumstances which may expose me to some risk of injury, because of the mature of horses, the facility, and the activities in which I will be engaged , In consideration of the Maine Benefit Horse & Pony Club allowing my participation in this event, I , on behalf of myself, and my heirs, administrators, personal representatives, assigns and children and spouse, if any, do, herbage to hold harmless, release and discharge Maine Benefit Horse & Pony Club, which includes its officers,directions, members,agents, reprentatives , affiliates and insurers , of and from all claims, demands , causes of action and legal liability whether known or unknown, anticipated or unanticipated,due to the ordinary negligence of Maine Benefit Horse & Pony Club, I shall not bring any claims, demands,legal actions or causes of actions against Maine Benefit Horse & Pony Club, for any damages or loss due to bodily injury, death, or property damage arising out of my participation in this event .
Warning
"Under Maine law, an equine professional has limited liability for an injury or death resulting from the inherent risks of equine activities"
7-A. Inherent risks of equine activities."Inherent risks of activities" means those dangers and conditions that are an intergral part of equine activities, including but not limited to:
A. The propensity of an equine to behave in ways that may result in damages to property or injury,harm or death to persons on or around the equine. Such equine behavior includes, but is not limited to bucking, shying, kicking, running , biting, stumbling, rearing, falling, and stepping on :
B The unpredictability of an equine's reaction to such things as sounds , sudden movements and unfamiliar objects, persons or other animals:
C. Certain hazards such as surface and subsurface conditions:
D. Collisions with other equines or objects : and
E. Unpredictable or erratic actions by others relating to equine behavior.
Signature :_____________________________Date: ____________
parent or guardian for riders under 18 yr.s
To pre- register , fill out this form and send to Kathye Monroe
626 E.Thorndike Rd..
Thorndike, Me. 04986
Or send this form via email to equine1@uninets.net
or call in your information at 207-568-5028
