1st Endurance Ride
Juniors must be accompanied by an adult sponsor (21+)
DOB is for Jr's only:) Format as MM-DD-YYYY
Current Coggins (within 12 months) present to ride management at registration or email a copy to firstname.lastname@example.org
Saturday, July 21
50 Mile $135.00
50 Mile (Jr to 16) $60.00
75 Mile $165.00
75 Mile *Jr to 16) $80.00
100 Mile $195.00
100 Mile (Jr to 16) $100
Horse AERC #
Horse ECTRA #
Owner AERC #
Extras & Payments
#Extra meals Fri @$16
Total Cost Fri Meals
#Extra meals Sun@$16
Total Cost Sun Meals
Meal Total Cost
AERC Non-Member Fee @ $15
LATE FEE /Day after 7/16/2018 ($35.00)
Cost of Ride Distance
I'd like donate & help feed a volunteer!
I'd like to make a tax deductible donation to Vermont Adaptive Ski & Sport (VASS)
Total Due *
Please make checks for the full amount, payable to Vermont Adaptive Ski and Sport and send to:
Vermont 100 Endurance Ride
PO Box 613
Brownsville, VT 05037-0613
NOTE: If you are NOT the horse owner, or the entry is for a JUNIOR (sponsored or not), a release form is available for download and signatures. Please still complete the release below.
VERMONT 100 ENDURANCE RIDE
MOONLIGHT IN VERMONT 75/50 RELEASE
Please read this release carefully and sign at the bottom.
I wish to enter and participate in the Vermont 100/75/50 Mile Endurance Ride. I will read all the rules and procedures for the ride and agree to comply with them. I agree to allow my horse to be drug tested, recognizing the risks therein. I am aware that an endurance ride can be extremely difficult and hazardous for even well–conditioned athletes under the most favorable conditions. I understand that the trail includes rough terrain with steep climbs, hard dirt roads and pavement, and the heat and humidity may be high. I am capable of negotiating this type of terrain on a horse. On more than one occasion, the horse trail deviates from the runner trail and the entry (ride and/or owner) accepts the responsibility of following trail markings and assumes full responsibility of correcting any error made on course. Any unsportsmanlike behavior of any part of this entry (rider, owner, crew) may result in elimination by an official or refusal of future entry to this ride by management. Nevertheless, in consideration of your accepting this entry, I hereby for myself, my heirs, executors and administrators, waive, release and discharge the Vermont Adaptive Ski and Sport (VASS), ECTRA, AERC, all persons assisting or connected with the ride, and all landowners, their representatives, successors and assigns, from any and all rights, claims, or liability for damage, for any and all injury to me or my property or those arising out of or in connection with my participation in this event. I further agree that I will defend, indemnify and hold harmless the Vermont Adaptive Ski and Sport (VASS), ECTRA, AERC, its members and agents, or any of them against all claims, demands and causes of action, including court costs and attorney’s fees, directly or indirectly arising from any action or other proceeding brought by me or prosecuted for my benefit contrary to this agreement. This release extends to all claims of every kind and nature whatsoever, whether known or unknown, and I expressly waive any benefits that I may otherwise have under provisions of the law of Vermont relating to the release of unknown claims.
I understand that this release constitutes a limitation on my legal rights. The undersigned verifies acceptance of risks and responsibilities for the rider’s and horse’s condition. Under
penalty of disqualification all information on this form is correct to the best of my knowledge.
Signature or owner or his agent duly authorized to make this entry:
BY SIGNING BELOW, I AGREE to be bound by terms and provisions of this entry If I am signing and submitting this Agreement electronically, I acknowledge that my electronic signature shall have the
same validity, force and effect as if I affixed my signature by my own hand.
I understand that if the horse I am riding is pulled for metabolic reasons and requires treatment on site or additional recheck by ride vet, this horse may not leave base camp until released by an authorized ride vet.
Rider Full Name
Rider I Agree
Parent/Guardian I Agree
Should be Empty:
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