Number: ________________12 & Under:______________Open:_______________

Name: __________________________ Age: ___________ Date of Birth: __________________

Address: __________________________City: _______________________Zip: ______________

Parent/Guardian: _____________________________  Phone:____________________________

PLEASE CIRCLE CLASSES YOU WOULD LIKE TO PARTICIPATE IN

ENGLISH CLASSES: 1  2  3  4  5  6  7  8  9  10  11      

LEADLINE CLASSES 12  13  14  15  16

WESTERN CLASSES: 17  18  19  20  21  22  23  24  25  26  27 28

Rider                        Class #                                      Name of Horse                               Amount

__________ # Of Classes x $4.95 per class =Total Class Fees: __________________________

                                                Total Amount Paid: _________________________  

                              **** MAKE CHECKS PAYABLE TO yloa

****** Liability and Medical Release **** I acknowledge that horseback riding is a sport which carries inherent risks and injury and damage to myself, others, horses and property. I KNOWINGLY ASSUME ALL RISKS.

In consideration of my participation in this event I agree that I will defend, indemnify and hold harmless YLOA and any agents or employees of the above against all claims, demands and courses of action, including court costs and actual attorneys fees arising from any proceeding or lawsuit brought by or prosecuted for my behalf. This agreement is binding on my executors, heirs and assignees. My initials at the bottom of this entry form acknowledges that I have read these liability and medical releases and the discipline procedures and policy, and I know and understand their contents.

Initials_________ Date: _______________Print Name__________________________________

Exhibitor/Rider Signature: _________________________________________________________

Address: _________________________________________City/Zip:_______________________

Parent/Guardian Signature (if under 18)_______________________________________________________