Santa Ynez Valley Riders
P.O. Box 72 Santa Ynez, CA 93460
MEMBERSHIP APPLICATION (Please PRINT this form and mail along with payment)
Calendar Year Y2K
Today's Date Application for (check one)
_Renewal Member _New Member _Day Member
Last Name First Name Spouse's First Name Phone#
Mailing Address City Zip Code
Street Address (if different than mailing address) City Zip Code
Type of Membership:
__FAMILY Mr&Mrs, with/without minor children $50 per year
__SENIOR Adult, 18 years & older $30
__JUNIOR Youth, Under 18 years of age $20
__DAY Per person, single event/day ride/ activity, any age $10
Memberships are renewed annually each January; notification is published in
the SYVR Newsletter.
The Officers and Board Members of Santa Ynez Valley Riders are dedicated to
providing safe and enjoyable ride/events for all members. We appreciate
your cooperation in carefully considering the following questions. Please
include any information about both horse & rider(s) that will be helpful in
providing a safe and healthy atomsphere during our rides. PLEASE PROVIDE
THE FOLLOWING INFORMATION:
I have attended a Club Meeting _Yes _No
I am a non-Rider but still wish to participate _Yes _No
I have had____ _Months _Years of Trail Riding experience (enter number
and check box)
My Spouse____________, has had___ _Months _Years Trail Riding experience.
Names and Ages of Minor Children and their trail riding experience
____________________________________________________
______________________________________________________________
Please explain any potential problems that the Trail Boss should be aware
of (e.g. horse has trouble crossing water, horse is nervous in a group,
group riding is new to you or your horse,
etc.)_______________________________________________________________________
_________________________________________________
I will be riding a 'green horse' _Yes _No
My horse trailers and loads easily _Yes _No _I don't know
I have access to a trailer and would be willing to trailer someone else
_Yes _No
I do not have a trailer, but would share expenses if someone has space.
_Yes _No
List other SYVR members you know well or live near
___________________________________________________
Please check the SYVR Committees you'd be willing to participate in:
_Phone _Christmas Party _Parade Ground Crew _Trails _Campouts
_Fun Days/Play Days _Parade Participant _Other_____
PARTICIPANTS HOLD HARMLESS AND INDEMNITY AGREEMENTS
THIS RELEASE CONTAINS IMPORTANT LIMITATIONS OF LEGAL LIABILITY. READ BEFORE
SIGNING!
THE UNDERSIGNED STATES AS FOLLOWS:
I acknowledge that competitive and pleasure horse riding contains inherent
risks of injury and damage to me personally, to my horse, to my equipment
and to the animals and property of others. Knowing these facts, I
nevertheless, in consideration of your acceptance of this form and my
application, do hereby for myself, my heirs, executors, and administrators,
waive, release, discharge, and hold harmless Santa Ynez Valley Riders, it's
Board of Directors, Officers, and all individual members thereof, and all
other persons and organizations in any way connected with the events,
property, boarding, lessons or any other activity described herein, their
represenatives, heirs, executors, administrators and asignees from any and
all right, claim, or liability for damages or for any and all injuries that
might be sustained by me inculding injuries to animals or from any and all
claims of any kind or nature that I might have as a result of, or arising
out of, my participation in any event, whether caused by my own act, or any
person or animal under my control. I further agree that I will defend,
indemnify and hold harmless Santa Ynez Valley Riders, it's officers,
directors, members, and agents or any of them against all claims, demands,
and causes of action including court costs and attorney's fees, directly or
indirectly arising from any action or other proceeding brought by or
prosecuted for my benefit. This release is extended to all claims of every
kind and nature whatsoever, whether known or unknown, and I expressly
waiver any benefits I may have under Section 1542 of the California Civil
Code relating to the release of unknown claims.
I understand that the liability insurance carried by Santa Ynez Valley
Riders covers only third party liability and in no way protects me nor
compensates me for and injury or loss.
I do acknowledge that I have read the foregoing paragraphs and know and
understand the content hereof.
Signature_________________________ Date___________________
Spouse Signature_____________________ Date_________________
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
For all MINORS, the following liability release must be signed by the
Parent(s) or Legal Guardian(s).
We, the undersigned parents/guardians of _________________ for and in
considerations of our child's participation at Santa Ynez Valley Riders
activities state that we have read the waiver, release and hold harmless
written above and we expressly agree that the terms and conditions of said
waiver, release and hold harmless shall apply to and be binding upon us and
our minor child insofar as it pertains to his or her participation, and to
any injury or damage said minor child or his or her horse may sustain or
cause as a result of said participation. We further warrant we have health
and accident insurance on said minor.
We further understand that an ASTM/SEI approved helmet will be worn by my
minor child(ren) while participating in all club sponsored riding activities.
I declare under penalty of perjury that the foregoing is true and correct.
I do acknowledge that I have read the foregoing paragraphs and know and
understand the content thereof.
Executed this ____ day of ______, ___at (city) _______________,
(county)____________________, State of ______________________.
Mother(print name) Father (print name) Guardian (print name) Phone#
Signature___________________________________ Date___________
Signature____________________________________Date___________