MeCTA MORE Clinics Entry Form

At what level(s) do you normally compete/ride?__________________

Will you need stabling?  Friday night___; Saturday night___

Rider's Name_____________________________________Age____

Address______________________________________________________

_____________________________________________________________

Phone__________________________

E-Mail_______________________________________________________

MeCTA Membership # (see your Omnibus label) _____________

What would you like to accomplish at this clinic? 

Are there any special issues you want to have addressed? 

Please attach a separate page if necessary.

Release:  I understand that this is a high-risk sport and that I am participating at my own risk.  I hereby assume this risk and further do hereby release and hold harmless the organizer, instructors, MeCTA, their officers, agents, employees and volunteers assisting in the conduct of this MeCTA educational activity, and the owners of the property on which it is to be held, from all liability for negligence resulting in accidents, damage, injury, death or illness to myself and to my property, including the horse(s) which I may ride.

Signature :________________________________________Date:______________

Must be signed by parent if participant is under 18

Note:  You will also be asked to sign a specific Farm release