Entry Agreement and Release Form
| Names: _______________________________________ | Telephone: ___________________________________ | ||||||||
| Street Address: ________________________________ | Business Phone: ______________________________ | ||||||||
| ____________________________ | Zip: _____________ | Birth Date: ___________________________________ | |||||||
| Name Parent/Guardian: _________________________ | If different from above: | ||||||||
| Street Address: ________________________________ | Telephone: ___________________________________ | ||||||||
| ____________________________ | Zip: _____________ | Business Phone: ______________________________ | |||||||
| E-Mail: __________________________________________________________ | |||||||||
| Allergies/Physical Impairments: | ___________________________________________________________ | ||||||||
| Location: The grounds and surrounding property at the Prince George's Equestrian Center in Upper Marlboro, | |||||||||
| Prince George's County, Maryland. | |||||||||
| Agreement: | |||||||||
| I/We the undersigned, understand that horseback riding and all related activities incidental thereto involve the risk of | |||||||||
| serious physical bodily injury and property damage. | |||||||||
| I/We hereby assume the sole responsibility for any and all bodily injury and or property damage sustained by me/us | |||||||||
| (including my child) while participating in any Free State ApHC sponsored horse show held at the above described | |||||||||
| location. | |||||||||
| I/We understand that as a condition of acceptance of the entry, the competition may use or assign photographs, | |||||||||
| videos, audios, cable-casts, or other likenesses of me and my horse taken during the course of the competition for | |||||||||
| promotion, coverage or benefit of the competition, or sport. Those likenesses shall not be used to advertise a product | |||||||||
| and they may not be used in such a way as to jeopardize amateur status. I hereby expressly and irrevocably waive | |||||||||
| and release any rights in connection with such use, including any claim to compensation, invasion of privacy, right | |||||||||
| of publicity, or to misappropriation. | |||||||||
| For good and valuable consideration, I/We, for myself/ourselves (including my child) and our heirs, legal | |||||||||
| representatives and assigns hereby release the Free State ApHC Inc., the Free State ApHC board of directors, | |||||||||
| the Free State ApHC officers, all Free State ApHC employees, volunteers, sponsors, vendors, and their heirs, legal | |||||||||
| representatives, successors and assigns, from all liability, claims, demands, costs, charges and expenses incident | |||||||||
| to personal injuries and property damage than may be sustained by me/us (my child) while participating in any of the | |||||||||
| Free State ApHC sponsored events or horse shows. | |||||||||
| Further, the undersigned agrees and promises not to assert against the Free State ApHC Inc., it's board of directors, | |||||||||
| it's officers, employees, volunteers, sponsors, vendors, and their heirs, legal representatives, successors and assigns, | |||||||||
| in any court of law, any claim or claims undersigned may have based on and all injuries or property damage sustained | |||||||||
| as a result of participating in any of the Free State ApHC sponsored events or horse shows. | |||||||||
| The undersigned also understands that it is required for all participants in English divisions and advisable for all | |||||||||
| participants in Western divisions at Free State ApHC horse shows to wear properly fitting protective headgear which | |||||||||
| meets or exceeds ASTM/SEI standards, carries the SEI tag, and has a properly secured chin strap at all times when | |||||||||
| on horseback and hereby represents that he or she or child has such protective headgear available for their use at all | |||||||||
| times. | |||||||||
| In witness whereof, I/We executed this release and covenant not to sue on this ________day of ___________ 2007. | |||||||||
| Signature: ______________________________________ | Signature: ___________________________________ | ||||||||
| Rider | Parent/Guardian | ||||||||
| Signature: ______________________________________ | |||||||||
| Witness | |||||||||