FOR PRE-ENTRIES, PLEASE PROVIDE INFORMATION BELOW EXCEPT FOR THE RELEASE AND EMAIL ENTRIES TO INFO@HOLLOWOAKFARM.COM BY 4PM ON THE FRIDAY BEFORE THE SHOWS. PLEASE BRING A COPY OF YOUR COGGINS AND SIGN A RELEASE ON THE DAY OF SHOW! COPY THIS FORM INTO YOUR EMAIL AND SEND IT ON OVER, NO PAYMENT REQUIRED, NO PENALTIES IF YOU PRE-REGISTER AND CAN'T MAKE THE SHOW. THIS MAKES IT EASIER ON SHOW AM TO HAVE ENTRIES ALREADY ON SHEETS. THANKS IN ADVANCE.

HOLLOW OAK FARM SUMMER SERIES RIDER ENTRY FORM
EX NUMBER:__________ DATE:________________ NAME:___________________________________________
TELEPHONE:______________________________________
ADDRESS:________________________________________
________________________________________________ EMAIL:___________________________________________
AGE AS OF 12/1/11 if junior:__________________________
VHSA NUMBER:____________________________________
BHSA NUMBER:____________________________________
AMATEUR:    Y    N                  JUNIOR:   Y     N
HORSES NAME:____________________________________
OWNER'S NAME:___________________________________
OWNER'S ADDRESS:________________________________
________________________________________________
HEIGHT OF ANIMAL:________________________________
VHSA REG:_______________________________________
COGGINS DATE:___________________________________
REQUISITION #:___________________________________ DIVISION:________________________________________
CLASS NUMBERS:__________________________________ ________________________________________________ ________________________________________________

WAIVER FOR RELEASE OF LIABILITY

ADVANCE RELEASE FOR ULTRA-HAZARDOUS ACTIVITY

___________________________________________(RIDER'S NAME) REFERRED TO AS PARTICIPANT, AND HOLLOW OAK FARM, INC., AS PROVIDER, BOTH PARTIES AGREE:

0. THIS ACTIVITY IS BY ITS NATURE HAZARDOUS AND DESPITE THE EXERCISE OF ALL DUE CARE, PERSONAL INJURIES OR DEATH MAY OCCUR WHILE RIDING HORSES. _________ (INITIAL).
0. HOLLOW OAK FARM, INC AND IT'S ENTITIES ASSUMES PARTICIPANT IS FULLY INFORMED ABOUT RISKS OF EQUINE ACTIVITY BY SIGNING THIS FORM AND PARTICIPATING IN EVENT._________(INITIAL).
0. PARTICIPANT, ON BEHALF OF PARTICIPANT AND HEIRS, SUCCESSORS AND ASSIGNS, HEREWITH RELEASES PROVIDER FROM ANY AND ALL LIABILITY FOR PERSONAL INJURIES, CONSORTIUM OR OTHER CLAIMS ARISING OUT OF PARTICIPATING IN THE EVENT, EXCEPT FOR ANY ACTION RESULTING FROM WILLFULL AND MALICIOUS ACTIONS BY THE PROVIDER.________(INITIAL).
0. I HAVE READ AND AGREE TO FOLLOW RULES LISTED IN HOLLOW OAK FARM INC., PRIZE LIST. I AM AWARE THAT FAILURE TO ABIDE BY RULES MAY CAUSE FOR DISQUALIFICATION FROM SHOWS.________(INITIAL).

SIGNED:____________________________________(PARENT SIGNATURE IF UNDER 18 YRS)

NAME PRINTED:____________________________________________________________________

RELATIONSHIP TO PARTICIPANT:_______________________________________________________