PLEASE READ CAREFULLY BEFORE SIGNING! EVENT SPONSORS OR CLUB ADMINISTRATORS DO NOT ASSURE YOUR SAFETY Riders competing for points for end-of-season awards MUST be Keller Saddle Club members and fulfill volunteer requirements. Texas Law (Chapter 87, Civil Practice and Remedies Code), an equine professional is not liable for the injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities. I acknowledge that I, the Participant, Parent or Legal Guardian, understand that Keller Saddle Club strongly recommends that all participants should wear ASTM-standard/SEI-certified equestrian riding helmets while participating in equine activities. I understand that the wearing of such headgear while participating in equine activities may reduce the severity of some of the participants’ head injuries in the event of a fall or other related accident. I acknowledge that I, the Participant, Parent or Legal Guardian, participate in this event totally at my own risk for injuries or property damage I or my family may incur; and I acknowledge that I, the Participant, Parent or Legal Guardian, et al., hereby release and hold harmless the sponsor, co-sponsors, their owners, their officers, directors, members, affiliated organizations and others acting on its behalf, from any claim, legal liability, legal action or right of damages, for any accident which may occur to me or my equine animal. I also assume and accept full responsibility for any damages done by me or my horse at this show, activity and/or event. I, the undersigned Participant, Parent or Legal Guardian, being of legal age, have read and understand the above agreement and release and have read, and agree to abide by, the Keller Saddle Club rules. IN WITNESS WHEREOF, PARENT/GUARDIAN has signed this release on this the _______ day of ___________________, _______________________________________ Rider’s Signature Parent/Guardian’s Signature (if Rider is a minor) I grant permission for Keller Saddle Club to use photographs taken of me at Keller Saddle Club events. Pictures will be for use on the club’s website and Facebook page for publication, promotion, and advertising of the Keller Saddle Club. Please do not use or reproduce any photographs or pictures of me or my family Playday Series KSC Member? YES [ ] NO [ ] Member: $15.00 $_____ Non-Member: $20.00 $_____ Arena Fee : $5.00 Per Rider $_____ Membership: ($35/$60) $_____ Donation: $_____ Other: ___________ $_____ TOTAL : $ ________ Circle Age Division Circle Events Ribbons? YES NO *Negative Coggins MUST be available in your possession to Participate. Rider’s Name: ___________________________________ Rider’s DOB: _______________ Age as of 01/01/2016: __________ KSC Use Only Received by: ____________ Coggins ____________Cash/Check # ____________ Amount: ___________ Lead LineIntermediate (15-25) Pee Wee (10 & Under) Senior (26-44) Junior (10-14) Classic/Super Sr (45+) Cloverleaf BarrelsPoles Event #3Event #4