Rider Registration/Release Form

Andreas Hausberger Clinic

JULY 15th-19th,  2002

Hosted by Jennifer Roth

Across the Diagonal Farm

8767 Carmel Valley

Carmel, CA 93923

Phone:  831-624-2848 or email: jroth@redshift.com

 

Interested in participating as a rider?  Please enclose this form along with payment for the number of lessons requested.  Full clinic fee is required on a first come first served basis, along with this release form.

 

Rider Name___________________________________________________

Address: ______________________________________________________

City_________________ State__________ Zip_______________________

Phone: ___________________Email________________Best time to call____________

 

Horses Name_____________________Age_____ Breed_________________

Horse’s training Level or any awards: ________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Rider Level/Past Training:

 

 

 

Fees: 

Rider Request for July 15th____ July 16_____  July17 _____ July1 8_____ July 19_____at $150 per ride or $750 for the full week.

Total Remitted__________

Please make checks payable to Jennifer Roth at the address above.  Confirmation of rider times will be called or emailed to you in advance.

 

Release and hold harmless agreement:

The Undersigned assumes the unavoidable risks inherent in all horse-related activities, including but not limited to bodily injury and physical harm to horse, rider and spectator.  In consideration, therefore, for the privilege of riding and/or attending above events at Across the Diagonal/Jennifer Roth, located at 8767 Carmel Valley Rd. Carmel, CA 93923, the undersigned does hereby agree to hold harmless and indemnify Across the Diagonal/Jennifer Roth, Andreas Hausberger, Vista Nadura, Masula II living trust, Durell D. Agha and all affiliated organizers and further release them from any liability or responsibility for accident, damage, injury, or illness of  the Undersigned or to any horse or other property owned by the Undersigned or to any family member or spectator accompanying the Undersigned on the Premises.

Signature__________________________________________

 Print Name:________________________________________

Signature of Parent/Guardian if under 18__________________________________

 

 

 

 

 

 

 

 

 

 

Clinic Information: http://jrdressage.freeservers.com/info.htm

Return: http://jrdressage.freeservers.com

Return to my homepage on Redshift: http://fp.redshift.com/jroth

Photos from Last Year’s Andreas Hausberger Clinic: http://jrdressage.freeservers.com/andreas.html