MORIAH FARM HORSE SHOWS, LC (“Moriah Farm Horse Shows”)
6218 Eastwood Drive, Warrenton, VA 20187 Phone: 301-252-4085
Across From the Fauquier County Fairgrounds
ONLY ONE HORSE TO EACH ENTRY FORM -- A COGGINS TEST MUST BE INCLUDED WITH ENTRIES
Horse No.
Office Use
Only / NAME OF HORSE / Color / Age / Sex / Height / ▼ Horse’s VHSA # ▼
ENTRY
FEES / Write Class #s Below Name of Corresponding Rider
Name of Rider: / ▼ Rider’s VHSA # ▼
Name of Rider: / ▼ Rider’s VHSA # ▼
Moriah Farm Show Dates
Circle Show You Are Entering
Saturdays: Sundays:
May 9th Hunter May 10th Jumper
May 30th Hunter May 31st Jumper
July 25th Hunter July 26th Jumper
August 1st Hunter August 2nd Jumper
September 26th Hunter September 27th Jumper
October 10th Hunter October 11th Jumper
/ TOTAL ENTRY FEES
Box Stalls @ $55.00
Day Before Weekend Hunter Schooling @ $25.00
OFFICE/EMT FEE - All Horses @ $20.00 / $20.00
TOTAL AMOUNT
AMOUNT ENCLOSED
Please Submit A Separate Entry Form For Each Show / BALANCE DUE
Ponies Specify: Small ______Medium ______Large ______ / MAKE CHECKS PAYABLE AND RETURN TO:
Moriah Farm Horse Shows, LC
6218 Eastwood Drive
Warrenton, VA 20187
Limited Stabling Available
Call For Reservations & Confirmations
STALLS MUST BE PAID IN FULL TO RESERVE
NO REFUNDS
* IMPORTANT NOTICE – READ BEFORE SIGNING BELOW *
Each undersigned Participant by signing below hereby acknowledges that he or she has carefully read the Equine Release, Waiver and Indemnification (“Release”) and the Media Release on the reverse side of this Entry Form or its separate Page 2 if said reverse side is blank; and each undersigned Participant expressly agrees that by signing below he or she has knowingly executed a waiver of his or her rights to sue and an agreement to assume all risks as provided and enumerated in the Release and Section 3.2-6200 et.seq. of the Virginia Code as amended. Each Participant is strictly responsible for obtaining and reading an Entry Form that has the Release and Media Release on the reverse side or on its separate Page 2 prior to signing below. Moriah Farm Horse Shows shall have no liability or responsibility for a Participant’s failure to do so.
Print Participant Rider's/Exhibitor’s Name / Print Participant Trainer's Name / Print Participant Owner’s Name
Street / Street / Street
City State Zip / City State ZIP / City State Zip
Telephone VHSA# / Telephone VHSA# / Telephone VHSA#
Email Address / Email Address / Email Address
Participant Rider's/Exhibitor’s Signature
______
Participant’s Parent’s, Legal Guardian’s or Representative’s Signature / Participant Trainer's Signature / Participant Owner's Signature
______
Print Participant Parent’s or Legal Guardian’s Name
______
Participant Parent’s or Legal Guardian’s Signature / Junior Rider’s DOB ______/ www.MoriahFarm.com
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ENTRY FORM
MORIAH FARM HORSE SHOWS, LC (“Moriah Farm Horse Shows”)
6218 Eastwood Drive, Warrenton, VA 20187 Phone 301-252-4085 ______
Across From the Fauquier County Fairgrounds Entry Number
Equine Release, Waiver, and Indemnification
The participants, their parents, or legal guardians (if the participant is under the age of 18 years) and others signing the front side or separate Page 1 of this Entry Form do for himself, herself or themselves whether an owner, lessee, trainer, manager, agent, coach, driver, rider or exhibitor and his, her or their heirs, successors, representatives, assigns, agents (individually and collectively “Participant”) hereby expressly waive all rights to sue and assume all risks of injury, death or loss; approve and consent to this release, waiver, and indemnification (“Release”); and thereby, agree(s) and represent(s) as follows:
To release Moriah Farm Horse Shows, its members, mangers, employees, officials, directors, employees, staff, agents, representatives, parent and affiliated companies (including without limitation Moriah Farm, L.C., and Grover, L.C.), and those other organizations/entities affiliated with or providing facilities or equipment to this activity/event (“Show”) (all of the foregoing hereinafter collectively “Indemnities”) from any and all liability, claims, suits, causes of action, judgments, settlements, loss, damage, costs, expenses (including attorneys fees and court and related costs through final appeal), all bodily injuries and death, injuries to their equine, and damage to their personal property arising out of their participation in any Show, it being specifically understood that said Show includes or may include the handling and/or riding of equine by those signing this Entry Form. Each Participant further agrees to indemnify the Indemnities and hold them harmless from any and all liability, claim, action, suit, cause of action, judgment, or settlement which may be brought or entered against them, loss, damage, cost, and expense, (including attorneys fees and court and related costs through final appeal) arising as a result of or in connection with the Participant’s participation in any Show whether or not any such damage or loss including without limitation injury or death resulted directly or indirectly from the negligent acts or omissions of one or more Indemnities.
Each Participant (including without limitation a parent or legal guardian if a Participant is under the age of 18 years) expressly acknowledges and agrees they are involved in equine activities pursuant to Section 3.2-6202 of the Code of Virginia as amended which is hereby incorporated herein by this reference and by signing on the front of this Entry Form knowingly executed this waiver of their rights to sue and agree(s) to assume all risks resulting from the "intrinsic dangers of equine activities". “Intrinsic dangers of equine activities" is defined as those dangers or conditions that are an integral part of equine activities, including but not limited to, (i) the propensity of equines to behave in ways that may result in injury, harm, or death to persons on or around them; (ii) the unpredictability of an equine's reaction to such things as sounds, sudden movement, and unfamiliar objects, persons, or other animals; (iii) certain hazards such as surface and subsurface conditions; (iv) collisions with other animals or objects; and (v) the potential of other participants acting in a negligent manner that may contribute to injury to the Participant or others, such as failing to maintain control over the equine or not acting within the Participant's ability, among other unspecified intrinsic dangers of equine activities.
This waiver shall remain valid unless expressly revoked by the Participant or parent or legal guardian of a Participant under the age of 18. The revocation shall be in writing which shall be delivered to and signed receipt obtained from an authorized representative of Moriah Farm Horse Shows and shall become effective thirty (30) days after delivery to and receipt obtained from such authorized representative of Moriah Farm Horse Shows.
If a Participant is an entity, the individual signing on its behalf hereby also personally accepts and agrees to all terms and conditions of this Entry Form including this Release and the Media Release below.
Each Participant hereby expressly represents and warrants that all medical and health insurance needed to cover all risks of any kind in any place in equine, and/or other related activities and events has been obtained and is in full force and effect.
Each Participant hereby expressly represents and warrants that he or she will wear and use all necessary safety equipment including a helmet approved by the American Society for Testing and Materials/Safety Equipment Institute and will ensure all such equipment including tack for each equine belonging to or leased by them is in good condition at all times.
Each Participant hereby expressly represents and warrants that he or she and any equine belonging to or leased by them will be subject to and abide by all Rules and Regulations issued from time to time by Moriah Farm Horse Shows for each Show while on or about Show property; that each will be eligible as entered; and that each will accept as final any ruling or decisions of Show Management with respect to the conduct of or any other matter pertaining to a Show.
Media Release
Each Participant (including without limitation the parent or legal guardian on behalf of a Participant under the age of 18) hereby voluntarily agrees and gives permission for Moriah Farm Horse Shows and its agents and assigns to use, record, film, photograph, audiotape or videotape in whole or in part his/her/its name, image, likeness, spoken words, performance and movement and their equine and personal property at any Show, in any form (hereinafter collectively referred to as “Works”), and to use, display, publish, distribute or exhibit these Works in whole or in part for the purpose of and in connection with any material that may be created by Moriah Farm Horse Shows, including, without limitation, for marketing, publicity, educational or related purposes on Moriah Farm Horse Shows’ or its assign’s website(s) and/or for commercial and other use in all manner and media including without limitation broadcasting on television, video, the internet or other media.
Each Participant hereby further agrees that Moriah Farm Horse Shows is the sole owner of all rights, title and interest, including copyrights in such Works and any parts thereof for all such purposes in perpetuity, as Moriah Farm Horse Shows shall determine in its sole discretion without limitation, reservation or compensation to any Participant.
By entering into this informed consent and release and granting the permission as stated herein, each Participant releases Moriah Farm Horse Shows and the Indemnities and indemnifies and holds them harmless from all liability arising out of or in connection with participation in any media events, including, without limitation, television broadcasts, promotional materials or website projects to the full extent provided in the above Release.
All capitalized terms in this Media Release shall have the same meaning as in the above Release.
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