Eastern Shore Trail Blazers 4-H & MS Gallop for a Cure
Present an Fun Ride Saturday March 7, 2009
& Open Schooling Endurance Ride/Fun Ride Sunday March 8, 2009 (Rain or Shine)
@ Assateague National Seashore Assateague Virginia ($5 daily park entrance fee)
Suggested Donation: $35 Adults, $10 children under 15, please make checks payable to
Montel Williams MS Foundation
Pre-registered participants are eligible for door prizes!
Competitive riders must check in by 8 a.m. non-competitive riders may leave at their leisure
anytime after 9 a.m.
Non-competitive chaperones are welcome to accompany minor competitive riders.
CHILDREN DO NOT HAVE TO BE ENROLLED IN 4-H for more information trndd@intercom.
net or (757) 854-1566
NON-COMPETTIVE RIDER (check here) ___
Competitive Riders circle the division of your choice Distance: ____6 mile _____14 mile
1. Open Adult Novice -Wave Runner
2. Intermediate/Advanced -Beach Comber
3. Green Horn -Sand Surfer (Walk/trot)
Youth and Adult Champion awards for best overall time!
Sign and complete bottom portion to pre-register mail to ESTB P.O. Box 114 Assawoman, VA
23302/or trndd@intercom.net
I agree to respect all property. I am responsible for keeping my mount under control. I shall
observe trail etiquette and will adhere to any instructions from ride management. I
UNDERSTAND THAT SAFETY HELMETS ARE REQUIRED FOR RIDERS UNDER 18 OR YOU
CANNOT RIDE AND ARE RECOMMENDED FOR ALL RIDERS. SORRY, NO STALLIONS, NO
BAREBACK RIDERS, NO DOUBLE RIDERS, NO LEADING HORSE/PONY, (NO “PONY-ING”)
NO DOGS ON TRAILS. PARENTS OR CHAPERONES MUST ACCOMPANY AND RIDE WITH
CHILDREN UNDER 13, PARENT OR GUARDIAN MUST RELEASE LIABILITY FOR CHILDREN.
WAIVER: In consideration of being permitted to participate in this equine activity, the
undersigned (Releasor) executes this Waiver and Release of Liability and Indemnity
Agreement (Release) and hereby agrees as follows: Releasor is aware of the risks of injury
and death inherent in Equine Activity and acknowledges that (s) he has read the above Rules
which are incorporated into and made part of this Release by this reference. Releasor hereby
expressly assumes all risk associated with all such Equine Activity.Releasor hereby releases,
waives and discharges Eastern Shore Trail Blazers 4-H Club & Virginia Cooperative
Extension Service, Assateague National Seashore and the Montel Williams MS Foundation its
officers, members, directors, employees, all other persons or entities acting on its behalf and
any and all landowners allowing the use of their land for this equine activity, and all
participant organizers (collectively, the Releasees) from all liability to Releasor, and his or her
spouse, legal representatives, heirs, successors and/or assigns, for any loss, injury or
damage, and any and all claims therefore, on account of injury to Releasor’s person or
property, or the death of Releasor while Releasor is engaged in any equine activity. Releasor
hereby waives his or her right to sue Releasees on account or injury to Releasor’s person or
property, or the death of Releasor while Releasor is engages in equine activity. Releasor
hereby indemnifies and agrees to hold harmless Releasees and each of them from any loss,
liability, damage or cost they may incur due to Releasor’s presence in, upon or around
property being used by the organizers for the purpose of this equine activity, or due to
Releasor’s participation in such equine activity regardless of where such participation may
occur. This release is governed by and shall be construed in accordance with Virginia Law
For the purposes of this Release, the terms “Equine Activity”, “Participant” and “Equine”
shall be defined in the Equine Activity Liability Act, Sections 3.1796.130 through 3.1796.133 of
the Code of Virginia ( the “Act”). Releasor expressly agrees that the Release is intended to be
as broad and inclusive as permitted by the Act and any other relevant provision of Virginia
Law and that if any portion hereof is held invalid, the balance shall; notwithstanding,
continue in full legal force and effect. § 3.1-796.132. Liability limited; liability actions
prohibited. A. Except as provided in § 3.1-796.133, an equine activity sponsor, an equine
professional, or any other person, which shall include a corporation, partnership, or limited
liability company, shall not be liable for an injury to or death of a participant resulting from the
intrinsic dangers of equine activities and, except as provided in § 3.1-796.133, no participant
nor any participant's parent, guardian, or representative shall have or make any claim against
or recover from any equine activity sponsor, equine professional, or any other person for
injury, loss, damage, or death of the participant resulting from any of the intrinsic dangers of
equine activities. B. Except as provided in § 3.1-796.133, no participant or parent or guardian
of a participant who has knowingly executed a waiver of his rights to sue or agrees to
assume all risks specifically enumerated under this subsection may maintain an action
against or recover from an equine activity sponsor or an equine professional for an injury to
or the death of a participant engaged in an equine activity. The waiver shall give notice to the
participant of the intrinsic dangers of equine activities. The waiver shall remain valid unless
expressly revoked in writing by the participant or parent or guardian of a minor.
----------------------------------------------------------------------------------------------------------------------------------------------
------------------------Name:________________________Signature (if minor parent or guardian
must sign):__________________________
Date: _____________Equine Name: ________________________Emerg. Contact Phone(s):
_____________________
e mail:_____________________Age (youth only)_________Coggins
#/Dte___________________________________
Present an Fun Ride Saturday March 7, 2009
& Open Schooling Endurance Ride/Fun Ride Sunday March 8, 2009 (Rain or Shine)
@ Assateague National Seashore Assateague Virginia ($5 daily park entrance fee)
Suggested Donation: $35 Adults, $10 children under 15, please make checks payable to
Montel Williams MS Foundation
Pre-registered participants are eligible for door prizes!
Competitive riders must check in by 8 a.m. non-competitive riders may leave at their leisure
anytime after 9 a.m.
Non-competitive chaperones are welcome to accompany minor competitive riders.
CHILDREN DO NOT HAVE TO BE ENROLLED IN 4-H for more information trndd@intercom.
net or (757) 854-1566
NON-COMPETTIVE RIDER (check here) ___
Competitive Riders circle the division of your choice Distance: ____6 mile _____14 mile
1. Open Adult Novice -Wave Runner
2. Intermediate/Advanced -Beach Comber
3. Green Horn -Sand Surfer (Walk/trot)
Youth and Adult Champion awards for best overall time!
Sign and complete bottom portion to pre-register mail to ESTB P.O. Box 114 Assawoman, VA
23302/or trndd@intercom.net
I agree to respect all property. I am responsible for keeping my mount under control. I shall
observe trail etiquette and will adhere to any instructions from ride management. I
UNDERSTAND THAT SAFETY HELMETS ARE REQUIRED FOR RIDERS UNDER 18 OR YOU
CANNOT RIDE AND ARE RECOMMENDED FOR ALL RIDERS. SORRY, NO STALLIONS, NO
BAREBACK RIDERS, NO DOUBLE RIDERS, NO LEADING HORSE/PONY, (NO “PONY-ING”)
NO DOGS ON TRAILS. PARENTS OR CHAPERONES MUST ACCOMPANY AND RIDE WITH
CHILDREN UNDER 13, PARENT OR GUARDIAN MUST RELEASE LIABILITY FOR CHILDREN.
WAIVER: In consideration of being permitted to participate in this equine activity, the
undersigned (Releasor) executes this Waiver and Release of Liability and Indemnity
Agreement (Release) and hereby agrees as follows: Releasor is aware of the risks of injury
and death inherent in Equine Activity and acknowledges that (s) he has read the above Rules
which are incorporated into and made part of this Release by this reference. Releasor hereby
expressly assumes all risk associated with all such Equine Activity.Releasor hereby releases,
waives and discharges Eastern Shore Trail Blazers 4-H Club & Virginia Cooperative
Extension Service, Assateague National Seashore and the Montel Williams MS Foundation its
officers, members, directors, employees, all other persons or entities acting on its behalf and
any and all landowners allowing the use of their land for this equine activity, and all
participant organizers (collectively, the Releasees) from all liability to Releasor, and his or her
spouse, legal representatives, heirs, successors and/or assigns, for any loss, injury or
damage, and any and all claims therefore, on account of injury to Releasor’s person or
property, or the death of Releasor while Releasor is engaged in any equine activity. Releasor
hereby waives his or her right to sue Releasees on account or injury to Releasor’s person or
property, or the death of Releasor while Releasor is engages in equine activity. Releasor
hereby indemnifies and agrees to hold harmless Releasees and each of them from any loss,
liability, damage or cost they may incur due to Releasor’s presence in, upon or around
property being used by the organizers for the purpose of this equine activity, or due to
Releasor’s participation in such equine activity regardless of where such participation may
occur. This release is governed by and shall be construed in accordance with Virginia Law
For the purposes of this Release, the terms “Equine Activity”, “Participant” and “Equine”
shall be defined in the Equine Activity Liability Act, Sections 3.1796.130 through 3.1796.133 of
the Code of Virginia ( the “Act”). Releasor expressly agrees that the Release is intended to be
as broad and inclusive as permitted by the Act and any other relevant provision of Virginia
Law and that if any portion hereof is held invalid, the balance shall; notwithstanding,
continue in full legal force and effect. § 3.1-796.132. Liability limited; liability actions
prohibited. A. Except as provided in § 3.1-796.133, an equine activity sponsor, an equine
professional, or any other person, which shall include a corporation, partnership, or limited
liability company, shall not be liable for an injury to or death of a participant resulting from the
intrinsic dangers of equine activities and, except as provided in § 3.1-796.133, no participant
nor any participant's parent, guardian, or representative shall have or make any claim against
or recover from any equine activity sponsor, equine professional, or any other person for
injury, loss, damage, or death of the participant resulting from any of the intrinsic dangers of
equine activities. B. Except as provided in § 3.1-796.133, no participant or parent or guardian
of a participant who has knowingly executed a waiver of his rights to sue or agrees to
assume all risks specifically enumerated under this subsection may maintain an action
against or recover from an equine activity sponsor or an equine professional for an injury to
or the death of a participant engaged in an equine activity. The waiver shall give notice to the
participant of the intrinsic dangers of equine activities. The waiver shall remain valid unless
expressly revoked in writing by the participant or parent or guardian of a minor.
----------------------------------------------------------------------------------------------------------------------------------------------
------------------------Name:________________________Signature (if minor parent or guardian
must sign):__________________________
Date: _____________Equine Name: ________________________Emerg. Contact Phone(s):
_____________________
e mail:_____________________Age (youth only)_________Coggins
#/Dte___________________________________
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