Statement of Rider and Liability Waiver Must be signed for valid entry   
  "I wish to enter and participate in the Southern California Peruvian Paso Horse Club (SCPPHC) 10 Mile Competitive Ride Clinic to be held June 3, 1999 at Cachuma Lake Recreation Area (part of the Santa Barbara County Parks Department) in the Santa Ynez Valley. I have read the rules, conditions and regulations of the event and will comply with them.
I understand that competitive riding involves being in remote areas for extended periods of time, far from communications, transportation and medical facilities. I also understand that these areas have many natural and man-made hazards which ride management cannot anticipate, identify, modify or eliminate. I further understand that horses can be excitable, difficult to control and unpredictable, that accidents can happen to anyone at any time and that such accidents can result in great bodily harm or even the death of the horse and/or rider. I, the rider and/or owner, agree to take full responsibility for myself and the animal I am riding.
I will hold SCPPHC, its officers and all individual members thereof, blameless for any accident, injury or loss that might occur due to my participation in the ride, and free from all liability for such injury, accident or loss. I understand that the liability insurance carried by SCPPHC in no way protects me or compensates me for any injury or loss.
I, the rider and/or owner, hereby certify that my horse is not under the influence of medication and will not be treated with or given any medication prohibited by SCPPHC rules. I, the rider and/or owner, also give permission to SCPPHC or any duly appointed agent to take any appropriate action deemed necessary to check for possible administration of drugs to my horse.
Signature below constitutes acceptance of the above terms and conditions. I have read and understood this liability waiver." 
 
Rider's Signature  _______________________________________ Date  ________________
   
Print Rider's Name  __________________________________________________________
   
Name of Registered Peruvian Paso Horse  ___________________________________________
   
Registration Number _________________________________________ (PPHRNA /AAOBPPH)
   
Signature of Registered Owner of Horse  ____________________________________________
   
Print Name of Registered Owner of Horse  ___________________________________________
   
In Case of Emergency, Notify  ___________________________________________________
   
Phone  ___________________________________________________________________
If Rider is Junior, Please complete following: 
   
Signature of Parent or Legal Guardian  _______________________________________________
   
Adult in attendance responsible for Junior Rider __________________________________________
 
  Mail to: Debbie Dutton. 9407 19th Street. Alta Loma. CA 91701   
Want to Join the SCPPHC Club? Click Here for Membership Application ~ Return to Show Schedule ~ Ride Rules ~ Entry Form
  This page created by Pasos on the Web! Placed April 26, 1999 Webdesigner