File - USC Horses At Work

ENTRY_________________
USC HORSES AT WORK
DERBY DAY ENTRY FORM
Please Print Clearly,
Thank You!
HORSE/PONY NAME ________________________________HEIGHT_________
RIDER
_____________________________________ NSEF # ________NSHJ#______
MAILING ADDRESS _______________________________________________________________________
(P.O. Box or Civic Address, City/Town, Postal Code)
DATE OF BIRTH___/__/___NSEF # _______NSHJ#______ (HORSE/PONY OWNER____________________)
CONTACT TELEPHONE # DAY _______________EVENING __________________CELL__________________
EMAIL: _____________________________________________________________
One entry form for each horse/rider combination. NSEF, EC Membership required(or written proof of
liability insurance with $5 million coverage). Membership to the Nova Scotia Hunter Jumper Association
is encouraged.
Please do not arrive to compete without prior acceptance of entries-limited entry as an evening event!
Div #
Division
Div Fee
DD
Derby Day
$30
PLEASE READ CAREFULLY.
WE THE UNDERSIGNED UNDERSTAND THAT RIDING AND CARING FOR HORSES ESPECIALLY IN A STRANGE SETTING SUCH AS A
COMPETITION, CLINIC OR TRAINING EVENT IS A DANGEROUS ACTIVITY AND THAT ACCIDENTS, INCLUDING INJURY AND POSSIBLY DEATH
CAN OCCUR WHEN PARTICIPATING IN THESE DANGEROUS ACTIVITIES. IT IS HEREBY RECOGNIZED THAT ALL EQUESTRIAN SPORTS
INVOLVE INHERENT RISK AND THAT NO HELMET, OR PROTECTIVE EQUIPMENT CAN PROTECT AGAINST ALL FORSEEABLE INJURY.
I HEREBY ACCEPT THESE RISKS AND HOLD HARMLESS USC HORSE AT WORK, THIS COMPETITION/CLINIC/EVENT, OFFICIALS,
ORGANIZERS, AGENTS, EMPLOYEES, VOLUNTEERS AND THEIR REPRESENATIVES, FROM AND AGAINST ALL CLAIMS INCLUDING ANY
INJURY OR LOSS SUFFERED IN CONNECTION WITH THE ABOVE NAMED EVENT, ANYWHERE ON THE GROUNDS AND SURROUNDING
AREA (i.e. practice area, stable, parking area) WHETHER OR NOT SUCH CLAIM, INJURY, OR LOSS RESULTED, DIRECTLY OR INDIRECTLY,
FROM THE NEGLIGENT ACTS OR OMMISSIONS OF SAID OFFICIALS, DIRECTORS, EMPLOYEES, VOLUNTEERS OR AGENTS OF USC
HORSES AT WORK, OR ITS COMPETITONS OR OTHER EVENTS. IT IS UNDERSTOOD THAT ALL RIDERS WHO DO NOT WEAR A PROPERLY
FITTED ASTM OR BSI APPROVED HELMET WILL NOT BE ALLOWED TO RIDE ON THE PREMISES.
SIGNATURE___________________________________________________________ DATE________________________
(Parent or Guardian if under 19)
PLEASE SEND ALL ENTRIES TO:
USC HORSES AT WORK
44 OLD CEMETERY ROAD
SWEET’S CORNER, NS, BON 2TO
horsesatwork@gmail.com