Horse number:______________________(We will assign this number)
Riders Name:__________________________Horses Name:_______________________
Address:_________________________________________________________________
Phone:____________________________Email:________________________________
Division: (please check)
1. Jr. Riders 12 and under__________
2. Jr. Riders age 13-19 years old_________
3. Sr. Riders age 20-40 years old_________
4. Riders age 41 and over_________
Entry contribution is $15. if received by Oct. 1st, 2008.
$20. after Oct. 1st
I have read the rules and regulations of the 2008 Acorn Run that were sent to me with this application or posted on the internet site. I understand I am responsible for any and all accidents, destruction, damage or harm, intended or unintended, to myself, my horses and or my equipment. I also understand that I am responsible for any accidents, destruction, damage or harm, intended or unintended I or my horse may cause to others. I do not nor will not hold Laurie Howell and or the other volunteers at the Acorn Run responsible for anything that happens to me, anyone who accompanies me, my mount or any items I have brought with me. I understand the Acorn Run and its organizer Laurie Howell are not a business and all fees donated are to help cover expenses.
Signed:____________________________________________________Date:_______________________
Parent/guardian signature if under 18:___________________________________Date:________________
Parent/guardian signature if under 18:___________________________________Date:________________
Amount enclosed: Mail to: Laurie Howell
Entry fee:________ 24870 CR 7660
Dinner:__________ Newburg,MO 65550