Adventure Trail Entry Form

Adventure Trail ENTRY FORM

TEAM Information

Preferred Ride Time (choose one- we will do our best to accommodate your preference)

RIDER Information

Name
Name
Rider First NAME:
Rider Last Name
Rider Age Category (choose one)

Rider Contact Information

Address
Address
City
State/Province
Zip/Postal

Emergency Contact Information

HORSE Information

Negative Coggins Report

Maximum file size: 67.11MB

ENTRY FEES

Entry Fees (select 1)

LIABILITY WAIVER

By submitting this form and payment I enter the WNRDC Adventure Trail which is made at my own risk and subject to the conditions of the sponsoring Club. Further, in doing so, I understand that this competition can be dangerous for both horse and rider, including sickness and disease (including communicable diseases.) In addition, I release the West Newbury Riding and Driving Club, its members, all volunteers, the Town of West Newbury, landowners, and organizers from any and all liability actions, causes of action, claims and demands of every kind and nature whatsoever which may arise in connection with or resulting from participation in any activities. I also give permission for the WNRDC to use any photograph, video or other likeness of me and my horse taken during the WNRDC Adventure Trail for promotion, coverage, or benefit of the club, with the condition that such likeness will not be used to commercially promote any product. 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. By electronically signing my name below, I agree. If under 18, the rider’s parent or guardian must electronically sign.

Payment Information

$
Payment total includes a $5.00 processing fee
Card Holder Name
Card Holder Name
First
Last
Card Holder Address
Card Holder Address
City
State/Province
Zip/Postal
Country
Card Information
Name
Name
First Name
Last Name