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Elisa Wallace Clinic

Rider Information

Rider Name:

Rider Address:

Telephone #:

E-mail Address:

Rider Date of Birth:  _______________________________________________________________________

Horse Name:  _____________________________________________________________________________

Horse Age:  _______________________________________________________________________________

Group Requests (we can try to accommodate): ______________________________________________

2019 Coggins Attached:               YES               NO

Clinic Format: 1 hour 45 minute session with 4 riders in each group

  • Saturday Only        
  • Sunday Only
  • Both Days

Jumping Height:

  • Pre-Elementary thru Elementary – up to 2 feet
  • Advanced Elementary thru Beginner Novice – 2’3 – 2’7
  • Beginner Novice thru Novice – 2’7-2’11
  • Novice Plus – 2’11 +

Payment:

  • Early Bird Special if paid before April 1st- $150 per day or $300 for both days
  • After April 1st - $175 per day or $350 both days

          Check #______________

        Cash

        Paypal- Please send it as “Family & Friends” for no fee to:  azraelacres@yahoo.com

*Please note anyone watching must purchase auditing bracelet for $20*

Mail To: Azrael Acres – 144 Williams Street, Uxbridge, MA 01569

Release

General Activity Release I hereby attend this competition at my own risk, subject to the rules of Azrael Acres. I hereby agree to be responsible for any injury or damages that may occur to, or be caused by any animals, vehicles, or trappings, or the loss of any animal, vehicle, or trappings belonging to or exhibited by me. I further agree to be absolutely responsible for the physical condition of any animal under my control or ownership and will also release, indemnify and save harmless the said competition, its show managers, volunteers, and Azrael Acres from any damage, expense and/or liability arising out of or resulting from any act or omission of the exhibitor or Azrael Acres or their agents, servants or employees. I certify that all my horse(s) are free from contagious disease. Warning: Under Massachusetts Law, an Equine professional is not liable for any injuries to, or death of, a participant in equine activities, pursuant to chapter 128, section 2D of the general laws.  Azrael Acres also reserves the right to add to or change groups as needed.

______________________________________________________________________________________________________________________

Rider Signature or Parent/Guardian if under Age 18                                                                 Date