Pre – Registration for the SRS Open
USDF accredited Dressage Clinic
Name:
__________________________________________
Address:
_________________________________________
Phone:
________________E-mail_____________________
IEO membership
Number____ (you do not have to be a member to attend)
The Clinic
will be held on July 15 through 19, 2008
Which dates
are you interested in Auditing?_________If so which dates ____________________?
Which dates
are you interested in Riding?________________________________________________
Do you have a
preferred time?___________________________________________________________
Do you wish ride with one other person? ___________(You will pay half price/if a ride partner can be found)
Clinic will be held at: Wellspring Farm
6164 Lineboro Road Glen Rock, PA 17327
Starts at 7:30 a.m.
Clinic Fees
Plus USDF fee $5
Lessons are:
$160 plus usdf fee
…………………..
York IEO Members
Audit: $20 per day & a covered dish if you wish
Plus USDF fee $5
Lessons: $150
plus usdf fee
$100 per ride non refundable but
transferable deposit required when booking
All Riders
please include your Neg. Cogging, current shots including rhino /EHV
( The Rhino shot must be within 30 days but no less than 10 days prior to clinic) with your release, Survey & Usdf info.
……………………………………
In
Consideration of being permitted by Dolly Broyles & Wellspring Farm Inc., (the
Clinic/Farm) to enter onto the premises and participate in a program or
activity. I hereby agree that I, my assignees, heirs, distributes, guardians,
their legal representatives will not make a claim against, sue, or attach the
property of where the clinic will be held in addition to Melanie Adams, York
IEO, & Dolly Broyles any of their principals, agents, employees or
representatives, for injuries or damages resulting from the negligence or other
acts, conditions, or circumstances, howsoever caused, by any principal. Agent,
employee, clinician, or representative of Wellspring Farm and York IEO its
representatives. From all actions, claims, or demands that I, my assignees,
heirs, distributes, guardians, or legal representatives now have or may
hereafter have for injury or damage resulting from my presence at The Clinic or
from my participation in a program or activity at The Clinic.
Signature____________________________. Date__________________
_________________________Signature of Parent /Guardian if rider auditor is under
21.
You can mail forms to and make checks payable to:
Melanie Adams c/o SRS clinic 5157 Jolly
Acres Road White Hall Maryland 21161
Please
submit your forms and money now to reserve your slot limited space available.