Rider Name *
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Jump Level - Between levels? then check 2 *
Payment Type *
Address *
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Phone # *
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City, State Zip *
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Trainer *
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Horse Name *
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Height *
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Age *
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Coggins Accession *
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Breed *
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Given by *
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By checking this box, I hereby agree to the following: I am participating at my own risk, subject to the rules of Lytle's Otasaga Farm, and I hereby engage to be responsible for any injury or damage that may occur to, or be caused by any animals, vehicles, or the loss of any animal exhibited by me and I further agree to be absolutely responsible for the physical condition of any animal under my control or ownership and will also release, indemnify, and hold harmless Lytle's Otasaga farm and event management from any damages, expenses and/or liability arising out of or resulting from any act or omission of the Exhibitor or Lytle's Otasaga Farm and/or their agents and employees, and certify that all my horses on the property are free from contagious disease. I also certify that I do not have COVID nor have been around anyone tested positive for COVID, that I do not have a temperature and am showing no symptoms of COVID. I further agree that anyone that accompanies me to this event is subject to this liability waiver and I agree to be responsible for them. *
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