Renegade Jackpot Series June 14 Registration
Located at Lansdowne Fair Grounds 1186 Prince St. Lansdowne, ON
Rider's Full Name
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First Name
Last Name
Horse's Name
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Insurance #
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Contact No.
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Format: (000) 000-0000.
E-mail
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example@example.com
Age Division as of Jan.1st 2025?
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Peewee 12 & Under
Youth 13-18
Senior 19+
Classes Being Entered:
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Day Pass, Grounds & Admin Fees $20
Peewee Barrels $5
Youth Barrels $10
Senior Barrels $20
Peewee Poles $5
Youth Poles $10
Senior Poles $20
Peewee Keyhole $5
Youth Keyhole $10
Senior Keyhole $20
Peewee Flag $5
Youth Flag $10
Senior Flag $20
Peewee Dash $5
Youth Dash $10
Senior Dash $20
Open Relay $10 Per Rider
If entering RELAY - Who is your Partner?
My total owing is:
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Waiver of Liability
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IMPORTANT NOTICE BY SIGNING THIS AGREEMENT YOU ARE GIVING UP CERTAIN LEGAL RIGHTS,INCLUDING THE RIGHT TO RECOVER DAMAGES IN CASE OF INJURY, ILLNESS, DEATH, ORPROPERTY DAMAGE, ARISING OUT OF YOUR RIDING OR USE OF A HORSE/PONY AND/ORPARTICIPATION IN ACTIVITIES AT THE ABOVE LISTED LOCATION INCLUDING INJURY,ILLNESS, DEATH, OR PROPERTY DAMAGE ARISING OUT OF THE NEGLIGENCE OF YOU OR THEPROPERTY OWNERS. READ THIS AGREEMENT CAREFULLY BEFORE SIGNING IT. YOURSIGNATURE INDICATES YOUR UNDERSTANDING OF AND AGREEMENT TO ITS TERMS. By checking this box, I hereby acknowledge on behalf of myself that I have familiarized myself with the activities that I will be allowed to participate in, and that I do hereby acknowledge and agree that I will participate in these activities without restriction or limitation. I recognize the inherent risks involved in riding and working with farm animals and horses, including but not limited to: Bites, kicks, abrasions or contusions from horses. Being thrown or bucked off by horses. Scratches or other injury from stalls or enclosures. Scratches or other injury from grooming tools and other equine equipment and tack. Allergic reactions to animals, hay, or other allergens. Tripping in holes or on materials or equipment. Slipping, falling, or otherwise being injured in the barn, in stalls, or on the grounds, which can be slippery, muddy, wet, or contain or present other hazards. I hereby specifically forever waive and release the property owners and its principals and agents from any liability for injury arising out of the inherent risks from riding, working or participating in a stable environment and/or with horses/animals/fowl, as well as from the active negligence of the property owners, its principals and agents. The property owners, staff and other clients are also not responsible for any lost, stolen or damaged items. By signing this Agreement, I hereby acknowledge my complete understanding, agreement and consent to my presence and/or participation in the activities at the above stated location, without restriction, without liability to the property owners, its principals or agents, and with full knowledge and understanding of the disclosures, waivers, and releases herein. If I am present at and participate in the activities at the above stated location, I do so at my own risk, and I hereby acknowledge and agree that the property owners, and any of its principals and agents shall bear no responsibility or risk associated with injuries or illness that could arise from my presence at the above stated location.
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