2012 family membership sheet by HC120831103615

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									                                                     2012 Family Membership

Date                                                                      Member Number                         12012f-

Last Name
Primary Member
           Member 2                                                                                                             D.O.B
           Member 3                                                                                                             D.O.B
           Member 4                                                                                                             D.O.B

Address


Phone Home                                                                           Cell
E-Mail
Barn
Trainer


 I agree to hold Dogwood Hunter Jumper Circuit, the ownership, management, agents, staff, their member organizations, affiliates,
 servants, other employees and agents harmless, without limitation as to amount against all liabilities, claims, causes of action and
 demands for personal injuries, damages or any claim of whatever nature or kind together with any resulting costs and legal fees,
 arising out of or caused by any act or omission or alleged act or omission Including a negligent act or omission of. Dogwood Hunter
 Jumper Circuit, the ownership, management, agents, staff, landlords or interested parties and their member organizations, affiliates,
 servants, other employees and agents thereof; occurring on or about Dogwood Hunter Jumper Circuit Show Ground premises: this
 agreement to hold harmless specifically and expressly includes liabilities, claims, causes of action and demands for personal
 injuries, property damages and/or any other claim of whatever nature or kind by or allegedly caused in whole or in part by the negligent
 or grossly negligent acts or omissions of Dogwood Hunter Jumper Circuit , the ownership, management, agents, staff, landlords or
 interested parties and their member organizations, affiliates, servants other employees and agents, without regard to amount.

                                     ALL ACTIVITIES ON THESE GROUND ARE SUBJECT TO THE INHERENT RISK LAW
                                                                      WARNING:
        Under Georgia Law, an equine activity sponsor or equine professional is not liable for an injury to, or the death of, a participant in equine
 actives resulting from the inherent risks of equine activities. Pursuant to chapter12 of title 4 of the code of Georgia annotated. O.C.G.A.’s 4-12-1 (1994)

 Under South Carolina Law, an equine activity sponsors or equine professional is not Liable for an injury to or death of a participant in equine
 activities resulting from the inherent risk of equine activities, pursuant to Article 7, Chapter 9 of Title 47, Code of Laws of South Carolina, 1976




 Signature
                                      (Must be signed by parent if member is under 21 years old)



Paid: Check #                             Amount      $40.00                         Date                                       Intl:

								
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