GYMKHANA REGISTRATION FORM                                                                                 No._______Cog._______
 

Circle Classes Entered:
1  2 3  4   5 6  7 8  9 10 11 12  13  14  15  16 17   18  19   20  21   22  23   24  25   26  27   28  29 30 31 32 33 34 35 36 37 38 39 40
 

Pre Entry -  $3 per class or $15/ day (Jr. age 13 & under) $20/day (Adult) $__________ ($40 Jr. or $50 Adult if entering all 3 events)       
Post Entry - $4 per class or $20/day (Jr) $25/day (Adult)  $__________

Multiple horses: $20 day pass for first horse, $15 for each horse with the same rider. (pre entry)  $25 first horse, $20 2nd horse (post entry)

Sponsoring which Class? ___________________________  $__________
Total          $__________
Proof of Negative Coggins required by State Law
Checks payable to Heath Agricultural Society.

Send Registration to:            Carol Lively
by August 14th 2008           11 Petrie Rd.                       cjlively@crocker.com
                                           Rowe, MA 01367                413-339-0252 (for more information)

Please pre-register if possible; you can pay on the day of the show. If the entries are done in advance it saves a lot of time and avoids confusion on the day of the event. Changes may be made on the day of the event. Thank you for your cooperation!

Warning: Under Massachusetts law an equine professional is not liable for an injury to, or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to section 20 of chapter 128 of the General Laws. I understand fully that participation in activities involving horses involves a high risk that could potentially result in serious injury even death.  I hereby acknowledge that I am participating at my own risk and agree to make no claims against Event Managers, Heath Fair, Heath Agricultural Society nor the town of Heath nor any of its residents or members for any damage or injury or loss which may occur to myself, my horse, or any vehicle or other article which I may send with my horse.  I agree to abide by the rules and accept the decisions rendered by the judges and the manager.  If I am under 18, I agree to wear protective headgear while mounted.
 ** Protective headgear recommended for all riders.**

Name___________________________________________________________________________________Age_______

Signature of Parent or guardian (if under18)_______________________________________________________________

Address_____________________________________________________________________Phone#________________

Horses Name___________________________________Age_________Breed___________________________________________