_______________________________________________ 90 Tifft Road
EVENT INFORMATION North Smithfield, RI 02896
RIDER ENTRY FORM
GREAT PRIZES FOR RIDERS!
Saddle Up! For St. Jude’s 10 Mile Pleasure Trail Ride
DISCLAIMER: Brookside Equestrian Center (BEC) is not
Sunday, April 24, 2005 (Rain Date: May 1, 2005)
responsible for any injury or loss of property to any person Not only will you be helping to save the lives of some very
suffered while attending, competing, or in any other way sick children, but you can win some great prizes too!
involved in the equine events at BEC for any reason
whatsoever, including ordinary negligence on the part of Participants raising $175 win
8:00 am Check in Opens
BEC, its officers, agents or volunteers. St. Jude’s cap, sweatshirt, sports bag, T-shirt &
8:30 am Course Opens
11:30 am Course Closes
Under Rhode Island law, an equine professional, unless he
12 - 2 pm Lunch
can be shown to have failed to be in the exercise of due care, Participants raising $125 win
2:30 pm Awards
is not liable for an injury to, or the death of a participant in St. Jude’s sweatshirt, sports bag, T-shirt & patch
equine activities resulting from the inherent risks of equine
Divisions: (Check One)
activities, pursuant to Chapter 21 of Title 4 of the Rhode Participants raising $75 win
Island General Laws. St. Jude’s sports bag, T-shirt & patch
G 17 & Under G 18-35 G 36-49 G 50 & Over
______________________________________________ Participants raising $35 win
Entry Fee: $25.00 including lunch
RIDER’S SIGNATURE (parent or guardian if under 18) St. Jude’s T-shirt & patch
Closing Date: April 18, 2005
NAME HOW TO PARTICIPATE
L Negative Coggins & Rabies Certificate must be
supplied for each participating horse.
1. Download the Sponsor Sheet from this website. Complete
LASTM/SEI approved helmets and appropriate leather
_______________________________________________ the rider information using a ball point pen and PRINT.
footwear w/heels must be worn by riders.
LTrails will be clearly marked. Riders may not digress
2. Set a goal for yourself by picking the prizes you want and
from the marked trails. Trail patrols will be
_______________________________________________ obtaining enough sponsors to earn them. Use additional
posted throughout the ride if there are questions.
TELEPHONE forms if needed. START TODAY. YOU MUST HAVE
SPONSORS TO REGISTER. DO NOT GO DOOR TO
This is a fund raising event to benefit St. Jude Children’s
_______________________________________________ DOOR TO OBTAIN SPONSORS.
Research Hospital. In addition to the entry fee, riders must
secure sponsors for their ride and raise a minimum of $35 to
3. Ask sponsors if the place where they work has a matching
participate in the ride.
_______________________________________________ gift program. If so, have them give you a completed form &
HORSE’S REGISTERED NAME turn it in to your coordinator with your pledges & donations.
RIDER MEDICAL INFO _______________________________________________ 4. Ask your family & friends to sponsor you. You can even
FARM GROUP OR STABLE AFFILIATION get sponsors from businesses in your town. The more
sponsors you have, the better your chance of winning prizes
and the greater benefit to St. Jude’s.
Date of Birth: ___________________________________
IN CASE OF EMERGENCY, PLEASE CONTACT:
5. Bring your completed sponsor forms with you to
Any known allergies or medical allergies:
_______________________________________________ registration on at BEC on the morning of April 24. If under
Contact 18, be sure your parent or guardian has signed the form.
_______________________________________________ 6. YOUR TAX DEDUCTIBLE DONATIONS ARE
Major illnesses: i.e., diabetes, heart condition, seizure
Telephone Number ALWAYS ACCEPTED!!
Full payment of entry fee must be sent with entry form. 7. Make pledge & donation checks payable to:
Please make checks payable to:
Medications currently prescribed: ____________________
Brookside Equestrian Center St. Jude Children’s Research Hospital.