2023 Uxbridge Fall Fair Competitive Western Speed Events.

Uxbridge Horsemen's Association Inc. Uxbridge Fall Fair Competitive Western Speed Event.

Sunday September 10, 2023
- Start time is 9:00 am SHARP. Registration is to be done online at www.uxbridgehorsemen.com no later than Midnight Thursday September 7, 2023
- One entry form per horse and rider combination.
- All riders and owners (if they are different) are required to carry their own liability insurance of no less than $5 million dollars. You may be asked for proof of insurance and/or your age. Bring your documents with you.
Date*

MonthDayYear
Date
Rider Full Name:*

First NameLast Name
Rider's Email:*
example@example.com
Horse:*
Barn/Coach Name (if applicable):
Owner: (if different from Rider)

First NameLast Name
Owner Email: (if different from Rider)
example@example.com
Rider Insurance Provider: (if different from Owner)
Rider's Policy Number and Expiry Date: (if different from Owner)
Administration Fee:

Classes: Non payout classes are $5 for UHA Members and $10 for Non-Members.

	UHA Member Fee	Non Member Fee
Keyhole Open $150 Added Money. UHA Members: $15.00, Non-Members $25.00
Stake Race Open $150.00 added Money. UHA Members: $15.00, Non-Members: $25.00
Down and Back Youth.
Down and Back Adult
Dash for Cash Open 3D $200.00 added Money. UHA Members: $20.00, Non-Members: $30.00
Flag Youth
Flag Adult
Flag Open $200.00 added Money. UHA Members: $20.00, Non-Members: $30.00
Poles Youth
Poles Adult
Poles Open 3D $200.00 added Money. UHA Members: $ 20.00, Non-Members: $30.00
Barrels Youth
Barrels Adult
Barrels Open 3D $500.00 added Money. UHA Members: $30.00, Non-Members: $40.00

Administration Fee: $10.00 per Entry.
Total $ Payable for Show Entry:
Waiver, Indemnity and Consent Agreement: I for myself, my heirs, executors, administrators, successors and assigns, hereby release, waive and forever discharge the Uxbridge Horsemen’s Association, all other associations, sponsoring companies, municipalities and owners and tenants of any property through which the Uxbridge Horsemen’s Association events may take place, their respective agents, officials, employees, representatives, successors and assigns, of and from all claims, demands, cost, and expenses in respect of death, injury, loss or damages of any kind to me, my horse or property howsoever caused , arising or to arise by reason of my participation in any association events, whether prior to, during or subsequent to the event notwithstanding that same may have been the result of the negligence of any of the aforesaid. The undersigned assumes the unavoidable risk inherent in all horse-related activities, including but not limited to bodily injury and physical harm to horse, rider and spectator. In consideration, therefore, for the privilege of participating in The Uxbridge Horsemen’s Association event, riding and working around horses at the Uxbridge Horsemen's Association Inc., events, held at The Uxbridge Fall Fair in Elgin Park, Uxbridge Ontario, the undersigned does hereby agree to hold harmless and indemnify The Uxbridge Horsemen's Association Inc., and its members and executive committee, The Corporation of the Town of Uxbridge and the Uxbridge/Scott Agricultural Society and further releases them from any liability or responsibility for accident, damage, injury or illness to the undersigns or to any horse owned, leased, rented or borrowed by the undersigned or to any family member or spectator accompanying the undersigned on the premises. I further undertake to hold and save harmless and agree to indemnify all of the aforesaid from and against any and all liability incurred by any or all of them arising as a result or in any way connected to my participation in any of the Uxbridge Horsemen’s Association’s events.
Please acknowledge our Waiver, Indemnity and Consent Agreement above by Initialing here:*
Owner Insurance Statement: $5,000,000.00 INSURANCE LIABILITY STATEMENT: I warrant that as a member of the Uxbridge Horsemen’s Association or participant in this event (show, clinic, trail ride etc.) that I carry $5,000,000.00 (FIVE MILLION) dollars of liability insurance and that it is in force as of the date of this event for all activities relating to the use and enjoyment of my horse(s) whether owned, leased, borrowed or rented.
Please acknowledge the $5,000,000 Insurance Liability Statement above by Initialing here:*
Name of Insurance Company covering you and your horse(s):*
Policy Number:*
Expiry Date:*

MonthDayYear
Date
Todays Date:

MonthDayYear
Date
Name of Insured:*

First NameLast Name
Signature of Insured:*

Clear
PROTECTIVE HEADGEAR WAIVER: All riders must wear ASTM approved Protective helmets.

I hereby understand that Uxbridge Horsemen’s Association, all other associations, sponsoring companies, municipalities and owners and tenants of any property through which the Uxbridge Horsemen’s Association events may take place, their respective agents, officials, employees, representatives, successors and assigns, are absolved from any responsibility, from any injury resulting from the improper use or refusal to wear protective headgear while on taking part in an Uxbridge Horsemen’s Association Inc., event. This includes any minor children in my care.
Please acknowledge our Protective Headgear Waiver above by Initialing here:*
Photographs and Video Disclaimer: Uxbridge Horsemen’s Association Inc. (UHA) reserves the right to use any photograph/video taken at any event sponsored by UHA, without the expressed written permission of those included within the photograph/video. UHA may use the photograph/video in publications or other media material produced, used or contracted by UHA including but not limited to: brochures, invitations, books, newspapers, magazines, television, websites, etc. To ensure the privacy of individuals and children, images will not be identified using full names or personal identifying information without written approval from the photographed subject, parent or legal guardian. A person attending a UHA event who does not wish to have their image recorded for distribution should make their wishes known to the photographer, and/or the event organizers, and/or contact UHA at P.O. Box 1494, Uxbridge, Ontario L9P 1N6, in writing of his/her intentions and include a photograph. UHA will use the photo for identification purposes and will hold it in confidence. By participating in a UHA event or by failing to notify UHA, in writing your desire to not have your photograph used by UHA, you are agreeing to release, defend, hold harmless and indemnify UHA from any and all claims involving the use of your picture or likeness. Any person or organization not affiliated with UHA may not use, copy, alter or modify UHA photographs, graphics, videography or other, similar reproductions or recordings without the advance written permission of an authorized designee from UHA. Thank you for your understanding and cooperation!
Please acknowledge our Photographs and Video Disclaimer above by Initialing here:*
By submitting this Waiver, Indemnity Form I acknowledge that I have read, understood and agree to all of the above content. INITIAL HERE:*

Clear

UXBRIDGE HORSEMEN’S ASSOCIATION INC.
the “Organization”
Facility Use Waiver
WAIVER OF LIABILITY FOR ALL CLAIMS AND RELEASE OF LIABILITY
PLEASE READ CAREFULLY BEFORE SIGNING.
Completed waivers must be returned prior to entry and use of the Organization’s facilities. This waiver does not affect accident and out-of-country travel insurance provided by the Organization where applicable.
By signing below, the Participant (named below) and/or the Participant’s Guardian understands and acknowledges, the risks, dangers, and hazards which are inherent on entering all lands, properties, facilities, structures, installations, vehicles or equipment owned, leased, operated or otherwise controlled by the Organization (the “Premises”), which risks include, but are not limited to: the potential for bodily injury or illness (including contraction of COVID-19); contact or interaction with others who may have been exposed to COVID-19; close proximity to or contact with surfaces, equipment, fixtures, or other objects that, despite the Organization’s efforts, may be infected with COVID-19 or other communicable illnesses; permanent disability, paralysis, or loss of life; collision with natural or manmade objects; tripping hazards; imperfect venue or field of play conditions; equipment failure; participants of varying skill levels; the negligent use of the Premises by others; inadequate safety measures or unsafe Premises; other circumstances known, unknown or beyond the control of the Organizer, its partners, sponsors, agents, affiliates, directors, employees, officers, therapists, or volunteers (together, the “Releasees”); or negligence or omission of the
Releasees (collectively, the “Risks”).
In consideration for allowing the Participant to use the Premises, the Participant and/or the Participant’s Guardian: (a) release, discharge and forever hold harmless the Releasees from any and all liability for damages or loss arising as a result of the Risks arising from entry into or use of the Premises; (b) waive any right to sue the Releasees in respect of all causes of action (including for injuries or illness caused by their own negligence), claims, damages or losses of any kind that may arise as a result of the Risks or in connection with entry into or use of the Premises, including without limitation the right to make a third party claim or claim over against the Releasees arising from the same; and (c) freely assumes all risks associated
with the Risks or anything incidental to the Risks, which may arise as a result of or in connection with use of the Premises. YOU ARE GIVING UP LEGAL RIGHTS TO ANY AND ALL FUTURE CLAIMS AGAINST THE ORGANIZATION AND RELEASEES.

I confirm that I have read and fully understand this waiver and release of liability. I sign this waiver and release of liability voluntarily without any inducement, assurance, or warranty being made to me.
Participant Name:*

First NameLast Name
Date of Birth of Participant:*

MonthDayYear
Date
Guardian Name (if the participant is a minor)

First NameLast Name
Today's Date:

MonthDayYear
Date
Signature of Participant or Guardian:*

Clear

Is the Participant under the Age of 18?*

YesNo

ACKNOWLEDGMENT OF RISK AND RELEASE OF LIABILITY (AR-0103)
For Participants Under the Age of Majority in the Province or Territory in which the Equine Activities are Provided by the Host
WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS. READ IT CAREFULLY!

The Parent/Guardian Must Read and Understand this Waiver Prior to Infant Participating in Equine Activities.
The following waiver of all claims, release from all liability, assumption of all risks, agreement not to sue and other terms of this agreement are entered into by me on behalf of the Infant Participant named below with and for the benefit of:
Uxbridge Horsemen’s Association Inc., its directors, officers, employees, volunteers, business operators, agents, and site property owners or lessees (the “Host”). Without limiting the generality of the foregoing, “Equine Activities” includes but is not limited to competitions, tournaments organized and /or operated by the “Host”, riding instruction, coaching and training provided by the "Host" to the Infant Participant.
Initial Each Item below after Reading and Understanding each item:
1. I am the Parent/Guardian of the Infant Participant and am executing this waiver on behalf of the Infant Participant in my capacity as Parent/Guardian and with the intent that this waiver be binding on myself and the Infant Participant for all legal purposes.*
Please enter your Initials
2. I am aware that there are inherent dangers, hazards and risks (“Risks”) associated with "Equine Activities" and injuries resulting from these "Risks" are a common occurrence. I am aware that the "Risks" of "Equine Activities" mean those dangerous conditions which are an integral part of "Equine Activities", including but not limited to:(a) the propensity of any equine to behave in ways that may result in injury , harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people or objects;(b) the unpredictability of an equine’s reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects; and(c) the potential for other participants to behave in a negligent manner that may contribute to injury to themselves or others, including failing to act within their abilities to maintain control over an equine.(d) the potential of natural or man-made hazards being present that can cause me harm, including communicable disease*
Please enter your Initials
3. I freely accept and fully assume all responsibility for all "Risks" and possibilities of any and all personal injury, sickness, disease, medical payments, death, property damage or loss resulting from the Infant Participant’s participation in "Equine Activities".*
Please enter your Initials
4. I agree that although the "Host" has taken steps to reduce the "Risks" and increase the safety of the "Equine Activities", it is not possible for the "Host" to make the "Equine Activities" completely safe. I accept these "Risks" and agree to the terms of this waiver on behalf of the Infant Participant, even if the "Host" is found to be negligent or in breach of any duty of care or any obligation to myself or the Infant Participant in the Infant’s participation in "Equine Activities".*
Please enter your Initials
5. In addition to consideration given to the "Host" for the Infant Participant’s participation in "Equine Activities", I and my heirs, next of kin, executors, administrators and assigns, as well as the Infant Participant and his/her heirs, next of kin, executors, administrators and assigns (collectively our “Legal Representatives”) agree:(a) to waive all claims that the Infant Participant has or may have in the future against the "Host";(b) to release and forever discharge the "Host" from all liability for personal injury, death, property damage, or loss that I, the Infant Participant, or our "Legal Representatives" might suffer as a result of the Infant Participant’s participation in "Equine Activities" due to any cause, including but not limited to negligence (failure to use such care as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake or error in judgment of the "Host"; and(c) to be liable for and to hold harmless and indemnify the "Host" from all actions, proceedings, claims, damages, costs demands, including court costs and costs on a solicitor and own client basis, and liabilities of whatsoever nature or kind arising out of or in any way connected with the Infant's participation in "Equine Activities".*
Please enter your Initials
6. I agree that this waiver and all terms contained herein are governed exclusively and in all respects by the laws of the Province or Territory of Canada in which the "Equine Activities" are provided by the "Host". I hereby irrevocably submit to the exclusive jurisdiction of the courts of that Province or Territory of Canada and I agree that no other court can exercise jurisdiction over the terms and claims referred to herein. Any litigation to enforce this waiver will be instituted in the Province or Territory of Canada in which the "Equine Activities" are provided by the "Host".*
Please enter your Initials
7. I confirm that I have had sufficient time to read and understand this waiver in its entirety. I understand that this agreement represents the entire agreement between the "Host", myself as Parent/Guardian, and the Infant Participant, and it is binding on myself, the Infant Participant and our "Legal Representatives".*
Please enter your Initials
Infant Participants Name*

First NameLast Name
Infant Participants Date of Birth:*

MonthDayYear
Date
Infant Participants' Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name;*

First NameLast Name
Parent/Guardian Date of Birth:*

MonthDayYear
Date
Parent/Guardian Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Parent/Guardian Signature:*

Clear
Signed this Day:*

MonthDayYear
Date

ACKNOWLEDGMENT OF RISK AND RELEASE OF LIABILITY (AR-0103)

For Participants Over the Age of Majority in the Province or Territory in which the Equine Activities are Provided by the Host
WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS. READ IT CAREFULLY!

Every Person Must Read and Understand this Waiver Before Participating in Equine Activities:
The following waiver of all claims, release from all liability, assumption of all risks, agreement not to sue and other terms of this agreement are entered into by me (the Participant) with and for the benefit of: Uxbridge Horsemen’s Association Inc., its directors, officers, employees, volunteers, business operators, agents and site property owners or lessees (collectively the "Host"). Without limiting the generality of the foregoing, "Equine Activities" includes but is not limited to, competitions, tournaments organized and /or operated by the “Host”, riding instruction, coaching and training provided by the "Host" to the Participant.

Initial Each Item below after Reading and Understanding each item:
Every Person Must Read and Understand this Waiver Before Participating in Equine Activities
The following waiver of all claims, release from all liability, assumption of all risks, agreement not to sue and other terms of this agreement are entered into by me (the Participant) with and for the benefit of: Uxbridge Horsemen’s Association Inc., its directors, officers, employees, volunteers, business operators, agents and site property owners or lessees (collectively the "Host"). Without limiting the generality of the foregoing, "Equine Activities" includes but is not limited to, competitions, tournaments organized and /or operated by the “Host”, riding instruction, coaching and training provided by the "Host" to the Participant.

Initial Each Item below after Reading and Understanding each item:
1. I am aware that there are inherent dangers, hazards and risks (collectively "Risks") associated with "Equine Activities" and injuries resulting from these "Risks" are a common occurrence. I am aware that the "Risks" of "Equine Activities" mean those dangerous conditions which are an integral part of "Equine Activities", including but not limited to:(a) the propensity of any equine to behave in ways that may result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people or objects;(b) the unpredictability of an equine's reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects;(c) the potential for other participants to behave in a negligent manner that may contribute to injury to themselves or others, including failing to act within their abilities to maintain control over an equine.(d) the potential of natural or man-made hazards being present that can cause me harm, including communicable disease.*
Please enter your Initials
2. I freely accept and fully assume all responsibility for all "Risks" and possibilities of any and all personal injury, sickness, disease, medical payments, death, property damage or loss resulting from my participation in "Equine Activities".*
Please enter your Initials
3. I agree that although the "Host" has taken steps to reduce the "Risks" and increase the safety of the "Equine Activities", it is not possible for the "Host" to make the "Equine Activities" completely safe. I accept these "Risks" and agree to the terms of this waiver even if the "Host" is found to be negligent or in breach of any duty of care or any obligation to me in my participation in "Equine Activities".*
Please enter your Initials
4. In addition to consideration given to the "Host" for my participation in "Equine Activities", I and my heirs, next of kin, executors, administrators and assigns (collectively my "Legal Representatives") agree:(a) to waive all claims that I have or may have in the future against the "Host";(b) to release and forever discharge the "Host" from all liability for any personal injury, death, property damage, or loss resulting from my participation in the equine activity due to any cause, including but not limited to negligence (failure to use such care as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake or error in judgment of the "Host"; and(c) to be liable for and to hold harmless and indemnify the "Host" from all actions, proceedings, claims, damages, costs demands, including court costs and costs on a solicitor and own client basis, and liabilities of whatsoever nature or kind arising out of or in any way connected with my participation in "Equine Activities".*
Please enter your Initials
5. I agree that this waiver and all terms contained herein are governed exclusively and in all respects by the laws of the Province or Territory of Canada in which the "Equine Activities" are provided by the "Host". I hereby irrevocably submit to the exclusive jurisdiction of the courts of that Province or Territory of Canada and I agree that no other court can exercise jurisdiction over the terms and claims referred to herein. Any litigation to enforce this waiver will be instituted in the Province or Territory of Canada in which the "Equine Activities" are provided by the "Host".*
Please enter your Initials
6. I confirm that I have had sufficient time to read and understand this waiver in its entirety. I understand that this agreement represents the entire agreement between myself and the "Host", and it is binding on myself and my "Legal Representatives".*
Please enter your Initials
7. I confirm that I have reached the age of majority in the province in which I am participating in "Equine Activities".*
Please enter your Initials
Participant Name:*

First NameLast Name
Date of Birth:*

MonthDayYear
Date
Participant Telephone #:*
Please enter a valid phone number.
Participant Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature of Participant:*

Clear
Signed this Day:*

MonthDayYear
Date

To complete your Entry please click on the Submit button below.

Important Information:

All entries must be accompanied by an etransfer in the amount shown on the first page. Please send your etransfer to treasurer@uxbridgehorsemen.com, please use the password Shows2023 for your etransfer.

A copy of your entry form will be emailed to the address provided to us. Please print and bring a copy with you.

Entry wristbands may be picked up Thursday September 7 2023 between 5pm and 8pm at the Elgin Park showgrounds. Please come to the show ring, and look for our UHA volunteers to get your wristbands. You may pick up a wristband for 1 Entrant, 1 Groom and 1 Driver. If you do not pick up your wristbands on Thursday night, you MAY be required to pay upon entry to the show on Saturday.

Don't forget to click on the SUBMIT button!!
Should be Empty:

Uxbridge Horsemen's Association Inc. Uxbridge Fall Fair Competitive Western Speed Event.