<p>Big Loop Hunter Pace Series Team Release 640 Artline Road, Eldred, PA 16731 Paid Coggins 2013 May 18 June 22 July 20 August 24 September 21 Oct. 19 Entry Form</p><p>Fees: Pre-Entries - $20 per person; $25 per person the day of the event. Checks payable to Big Loop. Pre-entries must be received 1 week prior to event. Pre- entry cancellations must be received at least one week prior to the event to receive a refund. For questions and location information, contact Jo Ann Squier, Chandelle Farm, 3171 Wesley Road, Bloomfield, NY 14469. 585-624-1853. Email: [email protected] or check the website www.chandellefarm.com On Fridays only before Paces, call 814-225-4406 if you have any questions. Boots and hard hats are required for all riders.</p><p>Name ______Telephone #______Address: ______E-mail address: ______</p><p>Partner’s name ______Telephone #______Partner’s Address: ______Partner’s e-mail address: ______</p><p>Check division entered: Novice ______(if under 18 must ride with an adult) Open ______</p><p>Big Loop reserves the right to cancel, combine or add divisions the day of the event.</p><p>RELEASE AND HOLD HARMLESS AGREEMENT: I understand horse related activities are high risk. I am participating at my own risk and I hereby assume the all risks inherent in all horse-related activities, including but not limited to bodily injury and physical harm to horse, rider and spectator and or property. I hereby agree to hold harmless and indemnify Big Loop Farm, and its Landowners and Associates, Chandelle Farm, and its Landowners and Associates, event volunteers, and organizers and further release them from any and all liability or responsibility for accident, damage, injury, death or illness to myself and to my property, including any horse owned by myself or to any family member or spectator accompanying me on the premises. Signature______date______Partners______date______Partners______date______</p><p>______Signature of Parent or Guardian if under 18 Don’t forget your Coggins!!!!!</p>