Lesson Student 2016 Winter Schooling Series Entry Form CLOSING DATE FOR ENTRIES 6:00 PM ONE WEEK PRIOR TO SHOWS THE DEATH OF A PARTICIPANT IN AN EQUINE ACTIVIY RESULTING WINDERMERE EQUESTRIAN CENTER FROM AN INHERENT RISK OF THE EQUINE ACTIVITY. ENTRY BLANK (ONE STUDENT PER ENTRY) SHOW DATES: January/February/March/April/May (CIRCLE ONE) Entries will not be accepted without signatures where indicated. Each signature indicates that the signatory has read and understands the COMPETITION Name of Rider: ______AGREEMENT printed on this Entry Form. Address: MAIL ENTRY TO: Windermere Equestrian Center 20615 Dunham Rd. City/State/Zip: Clinton Township, MI 48038 586-465-2170 Phone: Age:

Entry Fee per class, for all but lead line and walk trot, $18.00 Rider's Signature: Lead Line and Walk/Trot (per class includes horse rental) $18.00 Lesson Horse Rental: 3 or more classes (per day) $30.00 Classes for Rider (please list by number on prize list) 2 classes or less (per day) $20.00 Medal Classes are $25 on MHJA Local Member Date ONLY $25.00 Coaching per day: Required for all students who are jumping Optional morning schooling is included in this fee. $35.00 Coaching per day: Required for Students who are not jumping $25.00

. We make every effort to rotate students and to give everyone their favorite horse.  All competitors must wear headgear meeting ASTM/SEI standard with harness secured while mounted. Please remember how many students we have and understand that it is an impossible job to assign everyone their favorite horse. Permission for minor to show: I hereby consent to entry of my child: Horse Choices: 1. Parent/Guardian Signature : 2. 3. Every entry at a recognized competition shall constitute an agreement and affirmation 4. that the person making it, owner, lessee, trainer, manager, agent, rider and the horse: 5. 1) Shall be subject to the constitution and the rules of the Association and the local rules of the competition; 2) That every horse and rider is eligible as entered; 3) That the Instructor's Signature of Approval: owner, rider and any of their agents acknowledge that they participate voluntarily in the competition fully aware that horse sports and the competition involve inherent Number of classes at $18.00 dangerous risk of injury or loss, and they agree to hold the MHJA, Windermere Lesson Horse Rental: $30 per day 3 or more classes Equestrian Center and their officials, directors, employees and agents harmless for any $20 per day 2 or less classes ______injury or loss suffered resulting directly or indirectly from negligent acts or omissions Coaching per Day: # of days x ($25.00 or $35.00) of said officials, directors, employees or agents of the MHJA or Windermere Late fee (if applicable): $25.00 ______Equestrian Center. Total Due WARNING! UNDER THE MICHIGAN EQUINE ACTIVITY LIABILITY ACT, RECEIVED CHECK NO. ______AMOUNT PAID AN EQUINE PROFESSIONAL IS NOT LIABLE FOR ANY INJURY TO OR BALANCE DUE