Rider Registration/Release Form
Andreas Hausberger Clinic
JULY 15th-19th, 2002
Hosted by Jennifer Roth
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