OZARK COUNTRY ENDURANCE
RIDERS RIDER # ________
Pineville Turkey Trot 2004____RIDE ENTRY FORM
RIDER'S NAME: ________________________________________________________________
ADDRESS: ____________________________________________________________________
CITY: STATE ZIP: ______________________________________________________________
PHONE#:(________________________) EMERGENCY PHONE # _________________________
RIDER AERC#
________________________WEIGHT DIVISION ENTERED--
_________________
FEATHERWEIGHT (UP TO 160
POUNDS)-------LIGHTWEIGHT (161 TO 185 POUNDS)
MIDDLEWEIGHT (186TO 210 POUNDS)---------HEAVYWEIGHT (OVER 211
POUNDS)
JR RIDER Yes/No BIRTH DATE:
_____\______\_____
AERC MEMBER: Yes / No ------OCER MEMBER: Yes / No --------FIRST
RIDE: Yes / No
Sponsor’s Signature:
___________________________________________________________
EQUINE NAME:________________________________________ EQUINE AERC # __________
HORSE'S BREED:_______________________ AGE: ____________COLOR_________ SEX:______
Breed REGISTRATION
#_____________________________ (Not required unless I need to sign papers for a
breed registry program)
OWNER'S
SIGNATURE:_____________________________________________________________
ALL PARTICIPANTS MUST SIGN
LEGAL RELEASE BELOW
I wish to enter and
participate in the Pineville Turkey Trot Endurance
Ride to be held on November 26 & 27,
2004.
I have read and understand the rules, conditions, and
regulations of this event and hereby promise to comply with them.
In consideration of acceptance of my entry, I hereby, for myself,
my heirs, executors, administrators, and personal
representatives, do hereby waive and release Ozark Country
Endurance Riders, Ponderosa Trails, AERC, Ride management, all
ride personnel, all property owners over whose land the ride
crosses, their representatives, heirs, executors, administrators,
and assigns, from any and all right, claim, or liability of any
kind or nature, that I might have as a result of my free choice
or participation of myself or any member of my family in this
event. Further, I do hereby acknowledge that this release will
extend to any accidents, damages, or claims arising out of my
acts or the acts of anyone or any animal within or out of my
control. I hereby certify that I fully understand, and freely
assume the risks that endurance riding involves being on and
around equine animals in remote areas for extended periods of
time, far from communications, transportation, and medical
facilities: that these areas have many natural and man-made
hazards which ride management cannot anticipate, identify,
modify, or eliminate: that horses can be excitable, difficult to
control, and unpredictable: and that accidents can happen to
anyone at any time. I freely assume the risks that I or any
member of my family may suffer injury and/or property damage
and/or loss by participation in this event.
I HAVE READ AND UNDERSTAND THIS
LIABILITY RELEASE
RIDER:___________________________________________________________ DATE:___________
HORSE OWNER:
__________________________________________________DATE:
____________ JUNIORS: THE FOLLOWING MUST BE SIGNED BY A
PARENT OR LEGAL GUARDIAN
I hereby affirm that I
am the parent or legal guardian of this entrant and I hereby
release any person connected with this ride, their
representatives, heirs, assigns and successors from any
responsibility for personal injury to my child, or my child's
horse, or any property damage that may be incurred before,
during, or after this ride. I understand the risks involved and
assume full responsibility for such risks. I accept the complete
terms of the main release above as regarding my child.
SIGNATURE OF PARENT/LEGAL GUARDIAN:___________________________ DATE:______________
Camping Fees paid directly to
camp
Ride Entry Fees:(Includes
Friday evening meal)
50 Miles: Junior $ 50.00 Adult $ 75.00---------------------------Entry
Fee Amount $ _____________
25 Miles: Junior $ 40.00
Adult $ 60.00-------- AERC Member Discount
<$10.00> $< _________>
Cash Received___________
Check#____________ Total Amount Paid: $
__________________