MBHPC Hunter Pace
Please complete to participate in the Hunter Pace!
Email address *
Team Must Elect One Division *
Required
Requested Start Time. (We will do our best to accommodate within 30 minutes.)
Time
:
Rider #1 Name *
Your answer
Rider #1 Address (Street, City, State, Zip)
Your answer
Rider #1 Contact Phone Number
Your answer
Rider #1 Emergency Contact Name and Phone #
Your answer
Rider #1 Email Address
Your answer
Rider #1 Age
Your answer
Rider #1, If applicable, NAME OF PONY CLUB MEMBERSHIP
Your answer
Entry Fee *
Required
Signature Release: I understand that this is a high risk sport and I am participating at my own risk, I hereby assume this risk and further do hereby release and hold harmless Meadow Brook Hounds Pony Club, Lloyd Harbor Equestrian Center, New York State Park, their officers, agents employees, and volunteers from all liability from negligence resulting in a accident, damage, injury, or illness to myself or my property, including the horse or horses which will compete at this Hunter Pace. *
Your answer
Rider #2 Name *
Your answer
Rider #2 Address (Street, City, State, Zip)
Your answer
Rider #2 Contact Phone Number
Your answer
Rider #2 Emergency Contact Name and Phone #
Your answer
Rider #2 Email Address
Your answer
Rider #2 Age
Your answer
Rider #2, If applicable, NAME OF PONY CLUB MEMBERSHIP
Your answer
Entry Fee *
Required
Signature Release: I understand that this is a high risk sport and I am participating at my own risk, I hereby assume this risk and further do hereby release and hold harmless Meadow Brook Hounds Pony Club, Lloyd Harbor Equestrian Center, New York State Park, their officers, agents employees, and volunteers from all liability from negligence resulting in a accident, damage, injury, or illness to myself or my property, including the horse or horses which will compete at this Hunter Pace. *
Your answer
Rider #3 Name
Your answer
Rider #3 Address (Street, City, State, Zip)
Your answer
Rider #3 Contact Phone Number
Your answer
Rider #3 Emergency Contact Name and Phone #
Your answer
Rider #3 Email Address
Your answer
Rider #3 Age
Your answer
Rider #3, If applicable, NAME OF PONY CLUB MEMBERSHIP
Your answer
Entry Fee
Signature Release: I understand that this is a high risk sport and I am participating at my own risk, I hereby assume this risk and further do hereby release and hold harmless Meadow Brook Hounds Pony Club, Lloyd Harbor Equestrian Center, New York State Park, their officers, agents employees, and volunteers from all liability from negligence resulting in a accident, damage, injury, or illness to myself or my property, including the horse or horses which will compete at this Hunter Pace.
Your answer
FOR OFFICE USE ONLY: TEAM #
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