CCOBRA 2010 MEMBERSHIP FORM

Please fill out one form for each rider.

CLASS   (circle only one)         Open 4D                      Youth (15 & under)

NAME:   __________________________________________________

ADDRESS: _________________________________________________

STATE: ___________________ZIP CODE: _________________________

PHONE: __________________EMAIL:____________________________

HORSE’S NAME(S):___________________________________________

All CCOBRA information is available on our website:  CCOBRA.ORG

By signing the agreement, you are giving up certain legal rights, including the right to recover damages in case of injury, death or property damage.  Read this agreement carefully before signing it.  Your signature indicates your understanding of an agreement to its terms.

This is an agreement between the Undersigned (or minor in my charge) and CCOBRA.

I, ________________________________ (hereinafter the Undersigned) on behalf of myself.

1.        Acknowledge that horseback riding is a dangerous activity and involves RISKS that may cause SERIOUS INJURY AND IN SOME CASES DEATH.

2.       Knowing these facts and in consideration of your acceptance of this form, I voluntarily assume the risk and danger of injury or death inherent in horseback riding activities.  I hereby  RELEASE, DISCHARGE AND PROMISE NOT TO SUE, anyone involved in the production of this event, for any loss, liability, damage or cost to my person or property.

3.       Agree to abide by and follow any instructions given or rules established by CCOBRA or any Officers and Volunteers with regard to my participation in any event.

4.       The Undersigned expressly agrees that the foregoing release and waiver of liability, assumption of risk, and indemnity agreement is governed by the State of Arizona and is intended to be as broad and inclusive as is permitted by Arizona Law, and that in the event  any portion of this Agreement is determined to be invalid, illegal, or unenforceable,  the validity, legality and enforceability of the balance of the Agreement shall not be affected or impaired in an way and shall continue in full legal force and effect. 

5.       Acknowledgement that this document is a contract and agrees that any cost incurred for legal fees will be incurred by the undersigned.

I have read this document.  I understand it is a promise not to sue and a release and indemnity for all claims.

Signature_________________________________________________Date________________________________

IF THE PERSON WHO IS TO ENTER INTO THIS AGREEMENT IS UNDER EIGHTEEN (18) YEARS OF AGE, HIS/HER PARENT OR GUARDIAN MUST READ AND SIGN FOR THE MINOR.

Parent/Guardian Signature __________________________________Date______________________________