Pat Carter All-Breed Trail Challenge

2008 Membership Form

To purchase or renew your membership in the Pat Carter All-Breed Trail Challenge and to receive the quarterly newsletter “Trail Tails", please complete the information below and forward along with a cheque made payable to: Pat Carter Trail Challenge to:

Pat Carter Trail All-Breed Trail Challenge

c/o Kerry-Anne Janes

1 Victoria St., Branchton, ON  N0B 1L0

Please circle one:

Family……………$25.00                                                                  Individual…………..$15.00

(same household/children under 19 years of age)

SURNAME: ___________________________         FIRST NAME (S): _______________________________

ADDRESS: ______________________________________________________________________________

POSTAL CODE: ________________ PHONE NO.: ______________________________________________

E-MAIL: _________________________________________________________________________________

I would like to receive my newsletter by e-mail:   □ YES  □ NO

Waiver and Release of Liability

In consideration of being allowed to participate in any way in the Pat Carter All-Breed Trail Challenge equestrian program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1.        The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2.        I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3.        I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4.        I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Pat Carter All-Breed Trail Challenge, their officers, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGILGENCE OF THE RELEASEES OR OTHERWISE.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

X___________________________________________________

            PARTICIPANT’S SIGNATURE

X______________________________________     Date Signed: __________________

            WITNESS

FOR PARTICIPANTS OF MINORITY AGE

(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above.

X _______________________________________________          ______________________________

            PARENT/GUARDIAN’S SIGNATURE                                 EMERGENCY PHONE NUMBER

X _______________________________________________          ______________________________

            WITNESS                                                                               PRINT NAME