Mini Horse and Games 5/1 Mini Show and Games 5/1/22 Show Release Rider Name * Parent/Guardian if rider is under 18 Phone Number * Email * Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Emergency Contact Emergency Phone # Horse Name * Trainers Name Miniature Horse Division Mini In-Hand Mounted Mini In-Hand Trail Class Mini In-Hand Jumping with Jump off Mini In-Hand Driving Mini In-Hand Barrels Mini In-Hand Pole Bending Mini In-Hand Down and Back Games Division Single Game Two Games Three Games Four Games Unlimited Games First Choice Of Games – Choose up to 5 Barrels Poles Keyhole Down and Back Race and Lead Big T Simon Says W/T Simon Says W/T/C Costume Race Chase Me Charlie Hurry Scurry Catalog Race Ring Game Ribbon Race Musical Ribbons W/T Musical Ribbons W/T/C Line It Up Member? * I’m showing/riding a Line It Up horse I am not showing/riding a Line It Up Horse Release: I understand that horse sports may be hazardous and dangerous. I assume any and all risk of loss or injury to myself, my animals and equipment, other animals or persons, and agree to release from liability and to hold harmless Line it Up, LLC, all horse show personnel, and volunteers. WARNING: Under Pennsylvania law an equine professional and equine activity sponsor is not liable for an injury to or death of a participant in equine activities resulting from the inherent risks of equine activities. Inherent risks of equine activities includes: 1) The propensity of an equine to behave in a manner which may cause injury, harm or death to a person on or near it. 2)The unpredictability of an equine’s reaction to sounds, sudden movements, unfamiliar objects, individuals or other animals. 3)An equine’s reaction to certain natural hazards, such as surface and subsurface ground conditions. 4)A collision with other equines or objects. 5)An equine’s response to the participant’s manner of handling or controlling it or inability to handle or control it. Coggins Yes No Flu/Rino Yes No Competitor Signature(s) Signature of Competitor (18 and Over) / Signature of Guardian (under 18) * Clear Date Signed Payment * Pay with Paypal Pay in Person (cash, check, venmo) total If you are human, leave this field blank. Submit
