KSC Turn N Burn Registration

*Negative Coggins MUST be available in your possession to participate.

Riders Name: ___________________________________

Riders DOB: _______________ Age as of 01/01/2017: __________
Circle Age Division
REGISTRATION FEES:
Lead Line Intermediate (15-25)
Pee Wee (10 & Under) Senior (26-44) Entry Fee: $40.00 Per Rider $_____
Junior (11-14) Classic/Super Sr
(45+)
Arena Fee : $5.00 Per Rider $_____
Circle Events Donation: $_____
Other: ___________ $_____
Cloverleaf Barrels Poles
Straightaway Hitch N Go
Barrels TOTAL : $ ________

READ CAREFULLY BEFORE SIGNING!

SPONSORS OR CLUB ADMINISTRATORS DO NOT ASSURE YOUR SAFETY
Riders competing for points for end-of-season awards MUST be Keller Saddle Club members
and fulfill volunteer requirements.
Texas Law (Chapter 87, Civil Practice and Remedies Code), an equine professional is not liable for the injury to or
the death of a participant in equine activities resulting from the inherent risks of equine activities.
I acknowledge that I, the Participant, Parent or Legal Guardian, understand that Keller Saddle Club strongly recommends
that all participants should wear ASTM-standard/SEI-certified equestrian riding helmets while participating in equine activities.
I understand that the wearing of such headgear while participating in equine activities may reduce the severity of some of the
participants head injuries in the event of a fall or other related accident.
I acknowledge that I, the Participant, Parent or Legal Guardian, participate in this event totally at my own risk for injuries or
property damage I or my family may incur; and I acknowledge that I, the Participant, Parent or Legal Guardian, et al., hereby
release and hold harmless the sponsor, co-sponsors, their owners, their officers, directors, members, affiliated organizations
and others acting on its behalf, from any claim, legal liability, legal action or right of damages, for any accident which may
occur to me or my equine animal. I also assume and accept full responsibility for any damages done by me or my horse at this
show, activity and/or event.
I, the undersigned Participant, Parent or Legal Guardian, being of legal age, have read and understand the above agreement
and release and have read, and agree to abide by, the Keller Saddle Club rules.
IN WITNESS WHEREOF, PARENT/GUARDIAN has signed this release on this the _______ day of ___________________, 2017.

_______________________________________ _______________________________________
Riders Signature Parent/Guardians Signature (if Rider is a minor)

I grant permission for Keller Saddle Club to use photographs taken of me at Keller Saddle Club events. Pictures will be for
use on the clubs website and Facebook page for publication, promotion, and advertising of the Keller Saddle Club.
Please do not use or reproduce any photographs or pictures of me or my family.

KSC Use Only Received by: ____________ Coggins ____________Cash/Check # ____________ Amount: ___________