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HATRICK/APPLE KNOLL FARM
Apple Knoll Farm Jumper
Show Entry Form

SHOW DATE: ____________


PAID
OPEN CHECK
CASH



MAKE CHECKS PAYABLE TO: HATRICK INC. / APPLE KNOLL FARM, 25 Forest Lane, Millis, MA 02054
ONE ENTRY PER HORSE/RIDER COMBINATION
ONE CLASS PER LINE
CLASS
DIVISION
NAME OF RIDER
NAME OF HORSE
ENTRY FEE


































Total Entry Fee(s): $







RIDER INFORMATION
: PLEASE PRINT ALL INFORMATION CLEARLY

Rider/Participant Name:____________________________________________________

Address:________________________________________________________________

City/State/Zip: ___________________________________________________________

Date of Birth: _______________________ E-mail Address:______________________

Home Telephone: ____________________ Work Telephone: ______________________

Parent/Guardian Name (if Rider under 18): _____________________________________

Address of Parent/Guardian: ________________________________________________

Telephone of Parent/Guardian: (home)_________________ (work)_________________
JUNIOR / SENIOR (PLEASE CIRCLE ONE)

PLEASE NOTE: RELEASE & INDEMNITY AGREEMENT ON BACK, MUST BE COMPLETED AND SIGNED
WARNING:
Under Massachusetts law, an equine professional is not liable for an injury to, or death of, a participant in equine activities
resulting from the inherent risks of equine activities, pursuant to section 2D of chapter 128 of the General Laws
.
DIRECTIONS :
FROM 495 - EXIT 19 Rt. 109 East, approx. 8 miles to Millis, Turn Right on Rt. 115 - South, first left onto Forest Road,
straight at intersection (through stop sign), first right - See Apple Knoll Farm sign
FROM 95/128 - EXIT 16A Rt. 109 West, approx. 8 miles to Millis, Left on Rt. 115 - South, first left onto Forest Road, straight
at intersection (through stop sign), first right - See Apple Knoll Farm sign 2
BRIDLE#

CHECK#
CASH
2
RELEASE & INDEMNITY AGREEMENT

I hereby agree to indemnify and release Hatrick, Inc. and Apple Knoll Farm, and all associated persons,
employees, agents, and representatives from liability for any and all accidents or injuries sustained by me, my
employees, heirs, representatives, dependents, or guests, while participating in any equestrian related activity at
Apple Knoll Farm, or under the auspices of Hatrick, Inc.. It is understood that wherever the words Stable Owner
are used in this agreement, it includes landowners, stable owners, trainers, independent contractors, employees,
and any other individual related to the ownership or management of the horse and training facility of Hatrick, Inc.
and Apple Knoll Farm.

As an owner, student, contestant, spectator, employee, independent contractor, or parent, I/We, the undersigned,
recognize that all equestrian related activities are extremely dangerous, that accidents involving horses are
frequent, that the condition of the land is often hazardous, and that the ring/ground footing is rarely perfect. In light
of this knowledge, I/We undertake full responsibility for all harm that may come to me/ourselves, my/our stock, or
property, and all of my/our associates, dependents, representatives, and guests. I/We further understand that
wearing an approved hard hat is required at all times while mounted on Apple Knoll Farm property. With full
knowledge, I/We release the herein named Hatrick, Inc. and Apple Knoll Farm from any and all responsibility for
any and all accidents and injuries that may occur while either as a participant in or as a spectator of any equestrian
related activity at Apple Knoll Farm, or while training with trainers, independent contractors, or other individuals
related to Hatrick, Inc..

Signing this release implies that I/We have adequate medical and liability insurance/protection and that Hatrick, Inc.
and Apple Knoll Farm will assume no responsibility for horse and rider. Losses occasioned by the injury or death of
rider, spectator, or horse is agreed to be covered by the insurance of the undersigned and it is further agreed that
the undersigneds heirs, representatives, dependents, or guests shall have no right or action against Hatrick, Inc. or
Apple Knoll Farm employees, independent contractors, landowners, or any of their insurance carriers.

If the person is under 18 years of age, signature of the parent or guardian indicates acceptance of responsibility of
said parent or guardian and release of liability of the Stable/Owner and affiliated persons, as discussed above.

If damage is caused by or to the undersigneds horse or horses (including, but not limited to, escape from
enclosures), the undersigned takes full responsibility for damages to persons, property, or other horses and agrees
to indemnify Hatrick, Inc. and Apple Knoll Farm and affiliated persons against liability for such damages.

The undersigned further agrees to indemnify Hatrick, Inc. and Apple Knoll Farm against any liability for physical
loss or injury, or damage causing death, or making destruction necessary to the horse or horses of the undersigned
under the care of Stable Owner.

It is understood that Hatrick, Inc. assumes no responsibility for any personal property of the undersigned and any
said property is stored on the premises of Apple Knoll Farm at the sole risk of the Horse Owner.

Under Massachusetts law, an equine professional is not liable for an injury to, or the death of, a participant
in equine activities resulting from the inherent risks of equine activities, pursuant to Chapter 128, Section
2D of the General Laws.

I, hereby grant Hatrick, Inc. and Apple Knoll Farm, or their agents, the right to seek any and all emergency
treatment determined necessary to protect the health and well being of the above-named individual.

Parent/Guardian Name (if Rider under 18): _________________________________________________________
Signature: ____________________________________________________________Date: __________________
(Parent/Guardian must sign if rider is under 18 years of age)
Whom to Call In Case of Emergency: _____________________________Telephone:_______________________
Health Care Provider/Insurance #: ________________________________________________________________
Allergies: ____________________________________________________________________________________