Black Creek Hill Farms

Rider Name: _____________________________________________________________

Horse Name: ____________________________________________________________

Are You A BCHF Member?  Yes    No

What is your showing number? _______________

Classes:       1     2     3     4     5     6     7     8     9     10     11     12     13     14     15     16     17     18     19     20     21     22     23     24     25     26     27     28     29     30     31     32     33     34     35     36     37     38     39     40     41     42     43     44     45     46     47     48     49     50     51     52     53     54     55     56     57     58     59     60     61     62     63     64     65     66     67     68     69     70     71     72     73    74     75      76     77     78     79   80     81     82     83     84     85     86     87     88     89     90    91      92     93     94     95    96     97     98     99     100     101     102     103     104     105     106     107     108     109     110     111     112     113     114     115     116     117     118      119

 PLEASE INDICATE CLASSES BY CIRCLING – Must scratch 3 classes to receive refund

Number of Classes: ______

Price per Class: ______ ($7.00 non-members / $6.00 members)

Number Fee: □$1.00 (will be refunded when number is returned)

Total Due: _____________  Cash: □   Check: □ #________

Equine Liability Bill & Photo Release

In order to be protected, professionals or the equine activity sponsors business must display a warning notice in clearly readable print. The sign must contain the following warning notice:

Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina General Statutes.

The owners of Black Creek Hill Farms, all other sponsors and participants shall not be held responsible or liable for any accidents, injuries, damages or deaths occurring to any person, animal or property.  I understand and agree to all the above statements.

I grant to BCHF, its representatives and employees the right to take photographs of me and my property in connection with the above-identified event.  I authorize BCHF, its assigns and transferees to copyright, use and publish the same in print and/or electronically.I agree that BCHF may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Signature: _______________________________________________________  Date: ___________

Email: ___________________________________________________________

(Parent or Guardian must sign for rider under 18 years of age)