MAIL ENTRYFORMWITH CURRENT COPY OF COGGINSAND CHECKBY CLOSING DATE (1 week before)

1. Apple Tree Farm & Scarlet Hill Farm Schooling 3-Phase @ Scarlet Hill July 18, 2012 MAIL ENTRYFORMWITH CURRENT COPY OF COGGINSAND CHECKBY CLOSING DATE (1 week before) CHECKS PAYABLETO: Apple Tree Farm, POBOX463, Hollis, NH 03049 NAME________________________________________________________HOME PHONE ( ) _____ - __________ STREET_______________________________________________________E- Mail ____________________________ TOWN_____________________________________________STATE_________ZIP______________ AGE (IF JUNIOR)___________HORSE’S NAME________________________________________________ EMERGENCY CONTACT PERSON & PHONE # FOR DAY OF EVENTNAME___________________________________________PHONE ( )________________________ FEES: Entry fee: $110/division for 3-phase $65/division for 2-phase Refunds: No Refunds after the closing date. Prizes :Ribbons for each division. Please Check Division you are entering: _______Tadpole: 2011 Intro B Test, Jumps 18” (2-phase only) _______N/T*: 2010 Training Test A/ Stadium 3’3”/XC 2’11 _______Elementary: 2010 Beg. Novice Test A, Jumps 2’ _______Training: 2010 Training A Test, Jumps 3’3” _______Beginner Novice: 2010 Beg. Nov. Test A, Jumps 2’7 _______ P/T* : 2010 Prelim A/ Stadium 3’7/XC3’3” _______Novice : 2010 Novice Test A, Jumps 2’11” * N/T and P/T division available if sufficient entries. Time Start: Show starts at 8:00a.m. Divisions run from P/T to Tadpole . Times posted at: www.appletreefarm.orgor CALL 603-465-9592 I ENCLOSE A TOTAL OF $___________FOR THE AFOREMENTIONED ENTRY.I UNDERSTAND THAT THIS IS A HIGH RISK SPORT AND I AM PARTICIPATING AT MY OWN RISK. I AGREE FOR MYSELF, AND/OR MY CHILD, MY/OUR ADMINISTRATORS AND ASSIGNS, IN CONSIDERATION FOR MY (AND/OR MY CHILD’S) PARTICIPATION, TO ASSUME THIS RISK AND FURTHER DO HEREBY RELEASE AND HOLD HARMLESSAND INDEMNIFY THE APPLETREEFARM, JUDGES, OFFICIALS, VOLUNTEERS, AGENTS, EMPLOYEES AND THE OWNERS OF THE PROPERTY WHERE THE EVENT IS TO BE HELD, FROM ALL LIABILITY AND CLAIMS INCLUDING, BUT NOT LIMITED TO, CLAIMS FOR MONEY OR PROPERTY, DISABILITY, COVENANTS, ACTIONS, SUITS, CAUSES OR ACTION, OBLIGATIONS, DEBTS, COSTS, EXPENSES, ATTORNEYS’ FEES, JUDGMENTS, ORDERS AND LIABILITIES OF WHATSOEVER KIND OR NATURE IN LAW, EQUITY OR OTHERWISE, WHETHER NOW KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, AND WHETHER CONCEALED OR HIDDEN, INCLUDING BUT NOT LIMITED TO ANY STATE OR FEDERAL STATUTORY OR COMMON LAW CLAIM OR REMEDY OF ANY KIND WHATSOEVER ARISING OUT OF OR IN ANY WAY CONNECTED WITH ANY HARM TO ME OR MY HORSE AND FOR ANY HARM CAUSED BY ME OR MY HORSE TO OTHERS, EVEN IF THE HARM RESULTED, DIRECTLY OR INDIRECTLY, FROM NEGLIGENCE. WARNING: UNDER MASS/NEW HAMPSHIRE 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. PARTICIPANT SIGNATURE _____________________________________DATE_________________ PARENT OR GUARDIAN _______________________________________DATE_________________ PARENT OR GUARDIAN MUST SIGN IF PARTICIPANT IS UNDER 18 YEARS OF AGE Show at: Scarlet Hill Farm: 245 Lowell Road, Groton, MA 01450