Neda Flextime Program 2008

NEDA FLEXTIME PROGRAM 2014 Application Opening Postmark Date is February 15, 2014 Please indicate if you are: □ Junior/Young Rider □ *Adult Amateur * See USEF Rule Book, 13-B:GR1306 Name: ______Jr. / YR Age: ______Street Address: ______City: ______State: ______Zip Code: ______Phone Number: ______Email: ______

Student Biography: Please attach a short biography, (one for each instructor applied for) listing your short and long-term riding goals, what you feel are your current strengths and weaknesses, and what you would most like to work on in your lesson.

INSTRUCTORS: Choice (Rank 1st, 2nd, 3rd): You may sign up for up to 3 lessons, each with a separate instructor. ____ Jane Ashley ~ Windsor, VT ____ Jutta Lee ~ Woodstock, VT ____ Madeleine Austin ~ Williston, VT ____ Dee Loveless ~ Monson, MA ____ Joy Bahniuk ~ Harvard, MA ____ Jayne Marino ~ New Milford, CT ____ Beth Baumert ~ Columbia, CT ____ Rachel Markels Webber ~ Littleton, MA ____ Beth Beukema ~ Rehoboth, MA ____ Holly Mason ~ Lincoln, RI ____ Rita Brown ~ Kingston, MA ____ Bill McMullin ~ Stoughton, MA ____ Bobbi Carleton ~ Salisbury, CT ____ Patty Montana ~ Raynham, MA ____ Helen Cast ~ Danvers, MA ____ Annie Morris ~ Columbia, CT ____ Nancy Chandler-Conrey ~ Waterboro, ME ____ Deborah Moynihan ~ Bolton, CT ____ Yvonn Coleman-Larsen ~ Deerfield, NH ____ Jerilyn Nieder ~ Warner, NH ____ Leah Conathan ~ Duxbury, MA ____ Colleen O’Connor-Dzik ~ Holden, MA ____ Joy Congdon ~ Shelburne VT ____ Linda Parmenter ~ Hubbardston, MA ____ Leslie de Grandmaison ~ Auburn, NH ____ Jodi Pearson-Keating ~ Hopkinton, MA ____ Dorothy Demis ~ Townsend, MA ____ Paula Pierce ~ South Hadley, MA ____ Gretchen Demone ~ Rehoboth, MA ____ Lisa Pierson ~ Hopewell Junction, NY ____ David Donnelly ~ Old Chatham, NY ____ Michele Routhier ~ Nottingham, NH ____ Olav Drehn ~ Millbrook, NY ____ Kristen Schwaegerle ~ Rye, NH ____ Kimberley Brown Edelmann ~ Warner, NH ____ * Lisa-Claire Sigal ~ Bedford, NY ____ Pamela Goodrich ~ Boscawen, NH ____ * Sue Smith ~ Hudson, NH ____ Ann Marie Gregoire ~ Southwick, MA ____ * Catherine Haddad Staller ~ Califon, NJ ____ Mary Howard ~ Brentwood, NH ____ Alix Szepesi ~ Ipswich, MA ____ Jane Karol ~ Concord, MA ____ Kathy von Ertfelda ~ Dartmouth, MA ____ Allison Kavey ~ Millbrook, NY ____ Samantha Williams ~ Byfield, MA ____ * Elizabeth King ~ Goshen, NY ____Cindi Rose Wylie ~ Georgetown, MA ____ * Leslie Kornfeld ~ Maynard, MA ____Emily Wyman ~ Hudson, NY ____ Nancy Later Lavoie ~ Ashby, MA ____ Shan Lawton ~ Dorchester, MA * = New for 2014 ~ Crossed out instructors are full

Lessons are $45 for JR/YR and $50 for AA each. Riders are taken on a first-come basis by postmark ONLY. Separate check per form for each lesson applied for – Payable to NEDA – Send to: Carol Gordon, NEDA Flextime, PO Box 45, Norton, MA 02766

Flextime Program Release I, ______, do acknowledge that horseback riding poses potentially serious risks of injuries to participants and bystanders. I understand that persons or property may be injured as a result of my negligence, the negligence of others, or through no fault of myself or anyone else, because of the nature of the activity in which I am going to be engaged. I understand that horses may be unpredictable and difficult to control. With this knowledge, and as an inducement for the landowners and organizers to allow me to ride on the grounds, I agree to waive any and all rights that I or my family may have to make a claim against New England Dressage Association, landowners, farms, their agents, employees, organizers, members, or officers arising from any damages, injury, or death which I might sustain or which might occur to any horse that I am riding. I further agree to indemnify (hold harmless) all of the foregoing from any claims which I might make or which may be made on my behalf by others, or which may be made against me and/or New England Dressage Association by others, arising from riding, or due to my presence, on the premises, on the meeting grounds, private lands, or public roads used by the NEDA function. THIS RELEASE AND WAIVER OF LIABILITY CLAIM HAS BEEN READ CAREFULLY AND CLEARLY REPRESENTS MY INTENT WHEN SIGNING IT.

Date:______Print Rider’s Name: ______Rider’s Signature:______

Signature of Parent/Guardian:______Address & Tel ______