Wiarton Ride Registration Form

Wiarton Ride Registration Form
Current Chesley Saddle Club Membership Application has been completed and paid for.*
To participate in the Chesley Saddle Club Ride you and your families must be members. Please complete the membership form here if not already a member. This field must say yes to continue to register for the Wiarton 5 Day Ride.
Membership Page

https://form.jotform.com/donnamarypollard/ChesleyMembershipForm
Please indicate if you and your group are planning to Day Ride or Camp
Name of Person Completing this form *

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Please contact a member of the executive for specific questions, concerns, or if for some reason you are no longer able to attend after registration. Thank You

President: Emily Nonkes emily.uyl@hotmail.com

Vice-President Terry vanLenthe terryvanlenthe@hotmail.com

Secretary Joan Karr rjkarr55@gmail.com

Trail Committee Point PersonRon Karr rjkarr55@gmail.com

Treasurer John Gillberry jkgillberry@gmail.com

Food Point Person Judy Emmrich jemmrich4@gmail.com
Please only register individuals for one campsite, with the same arrival and departure dates on this form. If there are individuals at your site with different arrival and departure dates, please register them on a separate form.
Arrival Date*

MonthDayYear
Date
Departure Date*

MonthDayYear
Date
2nd Attending Spouse/Partner/Friend

First NameLast Name
3rdAttending Spouse/Partner/Friend

First NameLast Name
Will you have dependents at this ride:*
How many dependents:*
Dependent under 21 years of age.

First NameLast Name
Dependent under 21 years of age.

First NameLast Name
Dependent under 21 years of age.

First NameLast Name
Dependent under 21 years of age

First NameLast Name
Dependents Under 21 years of age.

First NameLast Name
Dependents Under 21 years of age.

First NameLast Name

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Wiarton 5 Day Ride
Categories:All

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Number of Campers 6 yrs to 14 yrs
$30.00CAD Quantity



Number of Campers 15 yrs and over
$60.00CAD Quantity



Number of Sunday Departure Day Breakfast
$8.00CAD Quantity



Sunday Departure Day Bag Lunches
$8.00CAD Quantity



Total

$0.00CAD
E-Transfer

Please do not send E-Transfer until you receive an email and assigned password from jot form. Email for treasurer is: treasurerrideontario@chesleysaddleclub.ca
Achnowledgment of Risk and Release of Liability

By signing this form, you are indicating that you are aware of the inherent dangers, hazards and risks associated with Equine and Camping activities and injuries resulting from these Risks and are aware these are a common occurrence.

By signing this form, you and your dependents and descendents are agreeing to waive all claims, release from all liability, assumption of all risks, and thus are in agreement not to sue now or in the future any and all participants, including any and all Landowners and Organizers of the Wiarton 5 Day Riding Event.

By signing this form, you as a parent or Guardian of a minor are executing this waiver waiving on behalf of them.

By signing this form, you as a registrant are signing on behalf of persons of age listed on this form and are acknowledging that you have explained this waiver to them and they are in agreement.

By signing this form, you are acknowledging you have had time to read and understand this waiver as it applies to the 5Day Wiarton Ride Landowners, Hosts, Participants and Guests.
Signature

Clear
Arrival Date and Departure Dates must be the same for all registrants on this form. Please use another form for individuals with different attendance dates.
Should be Empty:

Wiarton Ride Registration Form

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E-Transfer

Achnowledgment of Risk and Release of Liability