Versatility Clinic Entry Form Payment must be received either by check or by PayPal at time of entry to hold your spot. If payment is not received you are are not entered in the event.Clinic Date(Required) Month Day Year Name(Required) First Last Date of Birth(Required) Month Day Year Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Horse's Name(Required) Current (within 1 year) Rabies and Coggins requiredUpload Rabies and Coggins hereAccepted file types: doc, jpg, png, pdf, docx, jpeg, Max. file size: 32 MB.I will be competing in:(Required) Beginner Intermediate Advanced The cost is $50 per level entered.Level(s)(Required) In hand Beginner Novice Intermediate Advanced I will be paying:(Required) Check PayPal Mail payments to: Dawn Bonin Horsemanship, 577 Babcock Hill Road, Coventry, CT 06238Total Cost Permission to Photograph. I grant to Dawn Bonin/Babcock Hill, the right to take photographs of me and my family in connection with the above-identified program. I authorize Dawn Bonin/Babcock Hill, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Dawn Bonin/Babcock Hill 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.(Required)YesWaiver Signature. I hereby acknowledge and understand that horseback riding and the handling of horses and ponies are dangerous activities which can result in injury or death. I, the undersigned, from this date on, hereby release, indemnify, and hold harmless Babcock Hill Horses Naturally LLC, Dawn Bonin Horsemanship LLc and all owners and affiliations of property at this event, from any and all claims, actions, suits, and/or damages that may occur as a result of any injuries sustained while horseback riding, handling, or being near horses or ponies. This shall include all losses, damages, costs, and counsel fees that may occur as a result of injury, and related claims by any parties. I understand that inherent risks are involved in riding, handling, or being near horses and ponies. The inherent risks include but are not limited to the propensity of equines to behave in a way such as, running, bucking, biting, kicking, shying, stumbling, rearing, falling, or stepping on. Also the unpredictability of equines' reaction to such things as sounds, sudden movement and unfamiliar objects, persons, or other animals. By signing this agreement take full responsibility in the event of any injury. I have read this release, waiver and indemnity agreement, understand the risks involved and agree to assume them. I sign this agreement voluntarily and with full knowledge of its significance.*(Required)YesDate(Required) Month Day Year Signature(Required)I am(Required) Applicant Parent Payment Method*PayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
