CCBA Membership Form

CCBA Membership

Valid from November 1st 2021 through October 31st 2022.
Membership *
Membership Type *
All Youth Memberships must be accompanied by an adult membership
Primary Adult on Membership
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
E-mail *
example@example.com
Joint membership is for 2 adults in the same household. Please fill out the below information for the additional adult.
Full Name

First Name Last Name
Phone Number
E-mail
example@example.com
Will you be additionally getting youth memberships? *

Yes No
Youth #1 Name

First Name Last Name
Youth #1 Birthday

Month Day Year
Date
Youth #2 Name

First Name Last Name
Youth #2 Birthday

Month Day Year
Date
Youth #3 Name

First Name Last Name
Youth #3 Birthday

Month Day Year
Date
Are you interested in Sponsoring a Class at a CCBA show this year?

Yes $20 one time Class Yes $100 one Class all year: 5 shows Maybe, please contact me for more information Yes, I'm interested in $125 Show Sponsorship for VIP Parking No
Membership Type *
prev next ( X )
Individual Membership
$ 25.00

Joint Membership - 2 adults in same household
$ 40.00

Youth - Accompanying Adult Membership Required
$ 10.00 Number

Single Class Sponsorship One class sponsorship at one show. A board member of CCBA will reach out to you to inquire which class you'd like to sponsor.
$ 20.00

Class Sponsor for 2022 One class sponsorship at all 5 shows. A board member of CCBA will reach out to you to inquire which class you'd like to sponsor.
$ 100.00

Total

$ 0.00
Payment type *

Venmo Check
Your membership will become valid once we have received both your Membership form and payment. No points will accrue until membership is active.

Mail PDF forms & checks to

Vicki Tolhurst

16 Virginia Rail Dr

Marlborough, CT 06447

Or email PDF form to: jazztime16@aol.com

Make All Checks Payable to Jennifer Grayson (CCBA may be written in Memo line)

VENMO - CCBA-JG **You must add the name of the Primary adult on the membership form to the note on your VENMO payment. **Failure to do this may result in our payment not being counted**
Waiver of Liability

Each person engaged in recreational equestrian activities shall assume the risk and legal responsibility for any injury to his person or property arising out of the hazards inherent in equestrian sports, unless the injury was proximately caused by the negligence of the person providing the horse or horses to the individual engaged in recreational equestrian activities or the failure to guard or warn against a dangerous condition, use, structure or activity by the person providing the horse or horses or his agents or employees. CT Law (1997, Rev. Sec. 52-557p; 1993, P.A. 93-286, § 1.)

Covid Liability Release:

I agree that I am personally responsible for my safety and actions and for the safety and actions of any minors under my care while competing with CCBA and/or at the Glastonbury Hunt Club. I agree to comply with all policies and rules set forth by the state of Connecticut.

The undersigned agrees to release, indemnify, and hold CCBA, Glastonbury Hunt Club, its officials, board of directors, employees, volunteers, or additional locations where CCBA sanctions events may occur, harmless to any claims. Applying for Membership of CCBA constitutes agreement herein.
I agree to the above Waiver of Liability *

Yes
Should be Empty:

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