st_jude_entry_form

							                                                               _______________________________________________                               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!
Schedule:
                                                               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
                                                                                                                                             patch
            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
                                                               _______________________________________________
Policy Statements:
                                                               NAME                                                                        HOW TO PARTICIPATE
                                                               _______________________________________________
   L Negative Coggins & Rabies Certificate must be
                                                               ADDRESS
          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.
                                                               CITY,STATE,ZIP
   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
                                                               E-MAIL
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!!
disorder, etc.
_______________________________________________
                                                               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.