Yucaipa Barrel Racers Gymkhana Registration Form

11/15/2025 Gymkhana Registration Form
Event Details:

Time: Sign-ups begin: 7:30

Grand Entry: 8:45

Competitions Begin: 9:00

Location: Yucaipa Equestrian Center

Address: 13273 California St.

Yucaipa, CA. 92399

Phone Number: 951-452-1477
Welcome to Yucaipa Barrel Racer's First Independent Gymhana Event

We are thrilled to have you join us for this exciting event filled with thrilling competition, camaraderie, and the spirit of equestrian excellence. Whether you're here to race, cheer, or enjoy the day, your presence makes this inaugural gymkhana truly special.

All riders can choose to run all six of the featured events below or they can choose which event they would like to participate in that day at $5 per event. All riders, regardless of how many events they choose will required to pay for grounds fee of $20 for members and $30 for non-members

If you have any questions, don't hesitate to contact us at yucaipabarrelracers7@gmail.com
Name*

First NameLast Name
Horse's Name
Date

MonthDayYear
Date
Date of Birth *

MonthDayYear
**If under the age of 18 at the time of the application, A parent or guardian will need to provide their information.
Age
Parent or Legal Guardian Name

First NameLast Name
Parent or Legal Guardian DOB

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Preferred Contact Method

TextEmail
Are you a YBR Club Member?*

YesNo
YBR Current Ranking:*

AAA+AAAAAAFCFC 12 & UnderLL
Featured Events: (Select all or select which event or events you want to participate in)*

AllPoles ISpeed BallSingle StakeSpeed BarrelsFigure 8 StakeBarrels (Clover Leaf)
Would you like to participate in the Jackpot Barrel Race after? If no, you can add it later for $40*

YesNo
Ground Fees
An ASTM/SEI equestrian helmet is required for every rider under the age of 18 while mounted, regardless of in or outside the arena. No bicycle helmets are allowed. Helmets for riders 18 and over are encouraged, but not required

I understand and agree to comply if the rider is under the age of 18
Photo and Media Authorization

Do you allow Yucaipa Barrel Racers to take photographs or videos of you, and/or your child (and/or horse, if applicable) during events, and do you understand that these images may be used for promotional purposes, including being posted on Yucaipa Barrel Racers' social media accounts and website. Do you also acknowledge and agree that you or your family will not receive any compensation for the use of these images and that they will be used solely for promoting the organization and its events.
Photo and Media Authorization*

YesNo
Payment Options:
Payment Option*

Credit Card (Processing fee applies)PayPal (Processing fee applies)Zelle (Yucaipabarrelracers7@gmail.com)Venmo (@yucaipabarrelracers7)
Signature for Release of Liability:

I, the undersigned, understand that participating in Yucaipa Barrel Racers events involves risks of injury, death, and property damage. I voluntarily assume all such risks and agree to release and hold harmless Yucaipa Barrel Racers, its organizers, officers, volunteers, and sponsors from any and all claims, liabilities, or damages that may arise from my participation in these events, including those caused by negligence.

I further agree to indemnify Yucaipa Barrel Racers and its representatives from any claims made as a result of my actions during the event. I acknowledge that I am responsible for my own safety and actions while participating and agree to follow all event rules and instructions.

By signing below, I confirm that I have read and fully understand this Release of Liability, and I agree to its terms.

**Effective March 1, 2003; all riders under 18 are REQUIRED to wear a helmet when riding at all sanctioned shows.

YBR DOES NOT PROVIDE MEDICAL INSURANCE FOR ITS MEMBERS
Signature

Powered by Jotform SignClear
Credit Card total

Total With Ground Fees
Venmo Payment Info: @yucaipabarrelracers7
Zelle Payment info: yucaipabarrelracers7@gmail.com

Non-Member Total:
Should be Empty:

11/15/2025 Gymkhana Registration Form

Credit Card