Name: ___________________________________________
Spouse: __________________________________________
Children & age: ____________________________________
Address: _________________________________________
City: _____________________________________________
State: ___________________ Zip: _______________
Phone: ( ) _______ -
_____________________
Email address: _______________________________
NCHA Number (not required for membership)______________
__ New __ Renewal __ Address Change
__ $40.00 Family __ $35.00 Single __ $10.00 Youth (age 18 and under)
Release From Liability & Waiver Of
Responsibility
In consideration of the permission
granted to the undersigned to enter upon a portion of the property
that the Gold Country Cutting Horse Association is currently holding a
cutting, and the owners of said property and the surrounding grounds
the undersigned, for myself, my heirs, executors and assigns,
represent to and agree with Gold Country Cutting Horse Association,
and all said property owners, that I am well aware of the ordinary and
extraordinary hazards and risks ever present on the premises such as
those on which the Gold Country Cutting Horse Association cuttings are
held, because of the nature of the events conducted there and the
general use of the premises. I hereby assume all risks for any
accident resulting, directly or indirectly, from any occurrence at or
near said property for myself and my employees, if any, including any
and all expenses to me, and I hereby release, waive and discharge all
claims, demands and causes of action, past, present, or future, I may
have against the beneficiaries of this agreement with respect there
to. This release shall also cover the loss or crippling of any
livestock or for any injury or damage incurred by me or to any owner
or exhibitor or persons in my employ, in any manner whatsoever or from
any cause. I further agree that the provisions of this agreement
are sever able and that each of them is inoperative if it is not
enforceable against me, but that the non-enforceability of any of
these provisions shall not vitiate other provisions of this
agreement.
Dated this _____ day of _______,
_______
________________________________________
Signature of Member/Applicant
I, the undersigned, acknowledge and
understand that it is my responsibility to determine the eligibility
of any horse that I enter in a GCCHA cutting as well as my eligibility
to enter any GCCHA cutting. I agree to be responsible for
entering only classes for which I am eligible to show and I understand
that any points earned in a class for which either the horse shown or
myself was not eligible, will be revoked.
Dated this _____ day of _______,
_______
________________________________________
Signature of Member/Applicant
Print Out This Form, fill it out, mail with your check payable to:
GCCHA, 6624 Beech Ave., Orangevale Ca. 95662
All Owners and Riders Must Be Current Members ~ 2010 Show Season |
