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PINELLAS COUNTY HUNTER
ASSOCIATION, INC. MEMBERSHIP
APPLICATION 2002
NAME____________________________________________________________________
BARN AFFILIATION_____________________________________________________
ADDRESS:
____________________________________________________________________________________________________________________
STREET CITY
STATE ZIP
CODE
HOME TELEPHONE:
____________________________WORK______________________________FAX_____________________EMAIL__________________
JUNIOR 14 &
UNDER _____ 15-17_____JUNIOR’S DATE OF BIRTH _________________________ ADULT
18-35 _____ ADULT 36+_________
NAME OF HORSE OR PONY: ________________________________COLOR__________SIZE________ OWNED _____ LEASED__________
Under Florida law,
an equine activity sponsor or equine professionals is not liable for an injury
to, or the death of a pariicipant in equine activities resulting from the
inherent risks of equine activities. (Florida Statue 773.02)
In
consideration of being permitted to pariicipate in equine activities conducted
by Pinellas County Hunter Association Inc. the Florida State Fair Authority,
Bob Thomas Equestrian Center, Tampa, FI., releasor, for him/her/its self and
his/her/its personal representatives, heirs, and next of kin, releases, waives,
discharges and covenants not to sue Pinellas County Hunter Association Inc.
their officers, members, promoters, sponsors, advertisers, owners, and lessees
of the premises and each of them, their officers and employees, all referred to
as releasees, from all liability to the releasor, his/her/its personal
representatives, assigns, heirs and next of kin for all loss or damage, and any
claim or damage thereof, on account of injury to the person or property or
resulting in death of the releaser, whether caused by negligence of releasees
or otherwise, while the releaser is pariicipating in an equine activity.
Releaser
agrees to indemnify the releasees and each of them from any loss, liability,
damage or cost releasees may incur due to the presence of releasor in on or
about the Florida State Fairgrounds, whether caused by the negligence of the
releasees or otherwise.
Releaser assumes
full responsibility for and risk of bodily injury, death or property damage due
to negligence of releasees or otherwise while in on or about the Florida State
Fairgrounds while competing, officiating in, working, observing or for any
purpose participating in equine activities.
Releaser
agrees that this release, waiver, and indemnity agreement is intended to be as
broad and inclusive as permitted by the laws of the State of Florida and that
if any portion of the agreement is held invalid, it is agreed that the balance
shall, notwithstanding, continue in full legal force and effect.
Releaser,
being of lawful age, and the guardian of the minor named below (if applicable)
in consideration of being permitted to participate in equine activities, does
for his/her/its heirs, executors, administrators, and assigns, hereby release
and forever discharge the Florida State Fair Authority, Pinellas County Hunter
Association Inc., their heirs, administrators, and executors of any from any
and every claim, demand, action or right of action, of whatsoever kind or
nature, either in law or in equity arising from or by reason of any bodily
injury or personal injuries known or unknown, death and/or property damage
resulting or to result from any accident which may occur as a result of
participation in equine activities, or any activities in connection with equine
activities, whether by negligence or not.
Releaser
further states that he/she/it has carefully read the above release and knows
the contents of the release and signs this release as his/her/its owns free
act.
Releaser further
releases all officials and professional personnel from any claim whatsoever of
account of first aid, treatment or services rendered him/her/it during
participation in equine activities.
This release
contains the entire agreement between the parties to this agreement and the
terms of this release are contractual and not a mere recital. Parent or
Guardian of minor must sign below.
NAME__________________________________________________
MINOR’S NAME_______________________________________________________
Adult,
Parent Or Guardian
SIGNATURE
___________________________________________________________ DATE__________________________
Adult,
Parent Or Guardian
PLEASE MAKE
CHECKS PAYABLE TO P.C.H.A.
PAID BY CHECK # DATE
AMOUNT
MAIL TO MICHELLE
DRAIN 6301- 861H AVENUE NORTH SINGLE
MEMBERSHIP $10.00 / FAMILY MEMBERSHIP $25.00
PINELLAS PARK, FL.
33782 (727-546-7664) FAX (727-546-8624)