VERDA BARE BONES ENDURANCE: Sunday, May 19th, 2024

VERDA BARE BONES: Sunday, May 19th, 2024

Ride held at Cornish Fair Grounds: 294 Town House Rd, Cornish, NH 03745
Rider Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email*
example@example.com
Membership Info:

AERC Member NumberECTRA Member Number (If Applicable)
Weight Division. According to the AERC Rider Handbook: Featherweight (up to 160 lbs.), Lightweight (161 to 185 lbs.), Middleweight (186 to 210 lbs.) and Heavyweight (211 lbs. and up). These weights include tack.
Emergency Contact Name & Relationship*

First Name/Last NameRelationship to Rider
Emergency Contact Phone Number *

Area CodePhone Number
Rookie Rider?

NoYes
Junior Rider?

NoYes
Sponsor of Junior Rider:
Enter First Name/Last Name
Horse Name
Horse Breed & Registration (if applicable)

Horse BreedHorse Registration Number (if applicable)
Horse Membership Info:

Horse AERC NumberHorse ECTRA Number (If Applicable)
Horse Age
Horse Color
Horse Sex
Rookie Horse?

NoYes
Please select your ride entry option. Entry cost is based on the entry type you select in the drop-down menu for your distance. You can also select additional needs (stall, electric hookup, AERC non-member day fee) below. Selecting options below will give you a payment total. You must pay via check or Venmo (payment details follow your selections).*
prevnext( X )
50 mile entryAERC Endurance Distance
$ Free Entry type



30 mile entryAERC Limited Distance
$ Free Entry type



Intro Ride entry10 miles
$ Free Entry type



Reserved StallStalls are available for reservation on first-come, first-served basis. Your stall is not reserved until payment is received. You will be notified if a stall was available after receiving payment. You will be refunded if stall is not available.
$ Free Stall?



Electric hookup for trailerLimited spots for electric hookup available. No charge for camping/trailers without electric hookup.
$ Free Electric Hookup?



Non-AERC member day feeIf you did not enter your AERC member number above, you must pay this day fee.
$ Free Day fee for non-AERC members



Total

$0.00
PAYMENT DETAILS (Check or Venmo)

We can not accept payment via this form. But, you can submit this form to register electronically and then send the total specified above to Erin Grogan via Venmo: @Erin-Grogan-7 or Mail: PO Box 205, Reading, VT 05062. Your entry is not complete until payment is received. You will receive an email confirming your payment once received.
Please upload electronic images of your: 1) Current Coggins and 2) Proof of current Rabies vaccine. If you do not have them for upload with registration, they must be presented before you unload your horse at the Fairgrounds.

Cancelof
Agreement of Waiver Liability. I understand that the sport of horseback riding and driving is inherently dangerous and that serious injury and death can occur. I, agree that if any injury occurs to me or my horse or to any equipment that I may use or send for use, I, The undersigned, in consideration of accepting this entry, does hereby, for himself, his heirs, executors, and administrators will make no claim against the Vermont Riding and Driving Association (VERDA), Eastern Competitive Trail Riding Association (ECTRA), American Endurance Riding Conference (AERC),Cornish Fairgrounds or any of their Officers, Directors, Trustees, Employees and Volunteers. I further agree to hold VERDA, ECTRA, AERC, Cornish Fairgrounds and the Officers, Directors, Employees, Volunteers and any Landowners free and harmless from any liability, claims, suits, or damages of whatsoever kind or nature that may be occasioned by the horses used by me or the negligence of thepersons in charge of such horses and I agree to indemnify and hold harmless the organization and individuals against all liability, claims, suits and expenses including attorney fees incurred, arising out of any injury to any person or damage to any property caused by me, my horse or attendants. I signify that I have read, understand and accept the above by signing below. Must be signed by every competitor or guardian if entrant is under 18 years of age.*

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Name of Rider

First NameLast Name
Date of signature

MonthDayYear
Date
Signature of Horse Owner (if different from rider)

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Name of Parent/Guardian (if rider is 18 or younger)

First NameLast Name
Birthday of Junior Rider

MonthDayYear
Date
Signature of Parent/Guardian (if rider is 18 or younger)

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Drug Release. I hereby certify that my horse is not under the influence of medication. I hereby give permission to AERC or any duly appointed agent to check for possible administration of drugs to my horse by any appropriate or reasonable necessary method.*

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Name of Rider

First NameLast Name
Date of signature

MonthDayYear
Date
Signature of Horse Owner (if different from rider)

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Name of Parent/Guardian (if rider is 18 or younger)

First NameLast Name
Birthday of Junior Rider

MonthDayYear
Date
Signature of Parent/Guardian (if rider is 18 or younger)

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VERDA BARE BONES: Sunday, May 19th, 2024

PAYMENT DETAILS (Check or Venmo)