Hector Half Hundred Rides, Ride & Tie / Equathon Entry Form. Saturday, September 14, 2024, Hector, New York

Horse Information
Horse Name*
Horse Owner*

First NameLast Name
I wish to nominate a person authorised by the owner/rider to make treatment decisions if this horse is injured or ill and the rider/owner is not available.*

YesNo. I will leave all decisions to the ride manager, Dr. Pamela Karner
Authorised person's name*

First NameLast Name
Authorised person's phone number*
Please enter a valid phone number.
Breed
Color
Age
Sex

MareGeldingStallion
Coggins Accession Number*
A negative Coggins must be current within one year of the ride date. You will be able to upload a copy of your Coggins test below, or you can bring a hard copy to the ride.
Registry Number
Horse's AERC Number
ECTRA Number
Current Negative Coggins Form

If you have a digital copy of your current negative coggins, you can upload it here. Otherwise, bring a hard copy to the ride registration
Cancelof

Endurance Riders Only Liability Release Declarations

Ride & Tie participants should agree to the separate liability release declaration below.
RELEASE FORM ENDURANCE
This liability release and agreement must be signed and returned with your entry. No cross-outs or additions are permitted.
In consideration for permission to enter and participate in the Hector Half-Hundred 50-mile endurance ride, 30-mile limited distance ride, or 15-mile introductory ride, I do hereby for myself, my heirs and assigns, release and hold harmless ride management, ride volunteers, AERC, ECTRA, and their agents, officers, servants, employees and officials, from all claims, demands, actions and causes of action of any kind, for injury or death sustained by me or my horse, and damage to my property, incurred during this ride arising from negligence or any other fault. “Ride” includes from the time I and my horse arrive at base camp until the time that we leave the premises, as well as the actual event. “Horse” means the animal I am riding or have entered.

I understand that horseback riding is an inherently dangerous activity and am aware that (1) The ride involves being in areas for extended periods of time not close to communications, transportation, medical and veterinary assistance; (2) That these areas have natural and man-made hazards, which ride management cannot anticipate, modify, or eliminate; (3) That both my own horse and those of other participants can be excitable, difficult to control and unpredictable, and can panic, bite, rear, kick, strike, stumble or fall; (4)That as a result of participating in the ride I or my horse may be injured or die or my property may be damaged.

In the unlikely event that my horse is seriously ill or injured and I (rider/owner) am not available, I authorize ride management, acting on the permission of the person identified above, or Dr. Pamela Karner, 607-280-2282, if this person is not available), to authorize treatment (including referral), and if necessary, transport of the horse for that treatment. I assume responsibility for any resulting expenses.

In the event that the Rider/participant initiates a lawsuit against ride management, ride volunteers, AERC, ECTRA, and their agents, officers, servants, employees and officials as a result of his/her participation in the ride, and said Rider/participant fails to establish liability or fault of the above named entities, the undersigned agrees to pay all litigation costs and legal expenses incurred by the above named entities in defending said lawsuit. It is further agreed that the above named entities may assign their right to recover legal fees and expenses to their insurance carrier.

I agree to take full responsibility for my horse and myself. I recognize that the ride is a strenuous activity, and I represent that my horse and I are in adequate physical and mental condition to participate. I recognize that my participation in the ride is voluntary. I agree to wear certified (ASTM Fl 163/SEI) protective headgear at all times when mounted throughout the ride. In addition my participating equine will have a negative Coggins test dated within 1 calendar year from September 14, 2024. I also consent to a drug test upon my horse if requested.

I HAVE READ AND UNDERSTAND THE ABOVE LIABILITY RELEASE AND AGREEMENT, AND I AGREE TO BE BOUND BY ITS TERMS AND CONDITIONS.
Rider's Name and Signature
{riderName} Signature*
Date*

MonthDayYear
Date
Horse Owner's Name and Signature
{horseOwner} Signature*
Date

MonthDayYear
Date
Sponsored Junior Guardian's Name and Signature
{sponsoredJuniors} Signature*
Date*

MonthDayYear
Date
Ride & Tie Liability Release Declarations

Ride & Tie participants should agree to this release declaration.
RIDE AND TIE EQUATHON LIABILITY RELEASE:
NOTE: Both riders must be members of the Ride and Tie Association. THIS IS A RELEASE. IT CONTAINS LIMITATIONS ON LIABILITY. READ IT!!! I understand that Ride and Ties are hazardous activities which involve being in remote areas for a long time; that these areas have many natural and man-made hazards which race management cannot anticipate, identify, modify, or eliminate; that horses can be excitable, difficult to control, and unpredictable; and that accidents can happen to anyone at anytime, and that there is NO ambulance or medical help present. I UNDERSTAND THAT I AM ENTERING THIS EVENT AT MY OWN RISK and upon acceptance of my application for entry in the above-described race, I acknowledge that I assume FULL RESPONSIBILITY for my own safety. I and my heirs, executors, and administrators, will hold the Ride and Tie Association and all officers and directors thereof, any member of the race management and race personnel, and all property owners/tenants whose land the race crosses BLAMELESS for any injury or loss to myself or my horse which occurs due to my participation and free from all liability for such injury or loss. In short, I will not sue the race management, their personnel, landowners or tenants, and the Ride and Tie Association for ANY REASON! I am fully aware of all race rules and agree to abide by those rules set down by the race management and the Ride and Tie Association. I fully understand the consequences for not following race rules. As a participant in this race, I have read the above liability release and will agree to abide by ALL rules. In the UNLIKELY event that my horse is seriously ill or injured AND I (RIDER/OWNER) am not available, I authorize ride management, acting on the permission of the person identified above, or Dr. Pamela Karner, 607-280-2282 if this person is not available, to authorize treatment (including referral), and if necessary transport the horse for that treatment. I assume responsibility for any resulting expenses.
I grant my irrevocable permission to the Ride and Tie Association, its authorized agents, and the event photographer, to use my name and any photographs, videos, motion pictures, records, or any other record of my participation in this event
Ride & Tie Rider's Name and Signature
{riderName} Signature*
Date*

MonthDayYear
Date
2nd Ride & Tie Rider / Runner's Name and Signature
{2ndRider} Signature
Date

MonthDayYear
Date
Horse Owner's Name and Signature
{horseOwner} Signature*
Date

MonthDayYear
Date

Riders who are not already members of AERC will be required to pay a non member fee of $20. Select it on the payment form below.

Ride & Tie competitors must be members of the Ride & Tie Association. The fees are $15 for one day, $35 for an annual membership, and $50 for a family annual membership. Annual memberships run from January 1st to December 31st. If you are not currently a member, visit https://www.rideandtie.org/wp-content/uploads/2021/01/Membership-Form-2024r1-1.pdf for a printable form. There is also an electronic membership & payment form at https:// www.rideandtie.org/electronic-membership/.

RIDE FEES

Fees INCLUDE chicken BBQ dinner Friday evening, coffee, breakfast sandwiches, and donuts Saturday morning. There is a $20 fee for extra dinners. An extra dinner will need to be purchased for the 2nd Ride & Tie / Equathon competitor, if there is one.

Please note that preregistration requires a non refundable payment of $35. Any entries submitted, or deposits postmarked after 9/4/2024 will incur a $50 late fee. The balance can be paid at registration.

Ride & Tie ride entry fees are the same as for endurance riders for the same distances. Ride & Tie entrants will need to purchase an extra dinner.
Payment Form - select ride distance and AERC fee, if you are not currently a member

30 mile & 50 mile ride entry fee $15016 mile entry fee $95AERC nonmembership fee for 50 mile and 30 mile riders only $20
Extra dinners you wish to purchase
Outstanding Balance
Date

MonthDayYear
Date
What do you wish to pay now to reserve your spot?*
A minimum of $35 is required, which is non refundable. If paying by check, please make sure it's postmarked no later than 9/4/2023 to avoid a $50 late fee.
Balance Due at Registration
A $50.00 late fee has been added to your balance due.
Payment Preference*

PayPal.MeCheck
PayPal.Me

PayPal.Me link: https://paypal.me/pamelakarner1?country.x=US&locale.x=en_US
Check Payments

Please make checks payable to Pamela Karner. Mail your checks to

Eva Norris

PO Box 76

Harpursville, NY 13787.
Should be Empty:

Hector Half Hundred Rides, Ride & Tie / Equathon Entry Form. Saturday, September 14, 2024, Hector, New York

Horse Information

Endurance Riders Only Liability Release Declarations

Ride & Tie Liability Release Declarations