RED ROCK HOUNDS 2009 SUMMER CAMP REGISTRATION FORM

Name______________________________DOB_________________________________

Address___________________________________City___________________________

State, Zip _______________Phone___________________________________________

Date of Session Attending _________________________

Insurance Carrier_______________________Policy Number____________________________

Insured's Name___________________________________

Emergency Contact ______________________Emergency Contact Phone _________________

Any Known Allergies _____________________________Any Medical Conditions/Limitations

______________________________________________________________________________

For Juniors, please circle: Day Camper                         Overnighter

For all riders, please circle riding level: Beginner            Intermediate         Advanced

Will you bring your own horses?  ____________ How many?__________

Signature ____________________________ (Parent/Guardian must sign if under 18)

Printed Name _________________________

Amount Paid __________________ Date ______________  Check #/CC # _________________

WAIVER AND RELEASE:
I, the undersigned, acknowledge that as a rider/competitor, I am subjecting myself to certain risks or injury or damage to horse, rider, or equipment.  Knowing these facts, I nevertheless, in consideration of your accepting my registration, do hereby for myself, my heirs, executors, and administrators, do hereby agree to waive, release and hold harmless Red Rock Hounds, Lynn Lloyd, Angela Murray, their employees, agents, or representatives paid or unpaid, from any accident, death, injury, damage or theft that might occur to me, my horses, family, friends, or personal property while at Red Rock Hounds' Ross Creek Ranch.  I have read the above statement and understand my rights.

Signature of Rider_____________________________________     Date __________

Signature or Parent/Guardian ____________________________     Date _________