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Buckeye Horse Pullers Assoc. of Ohio, Inc.

Membership Form & Liability Form

 

Send $20.00 to:                    Buckeye Horse Pullers Assoc. Ohio, Inc.

                                                          11231 Bean Road

                                                Chardon Ohio 44024

 

Name:                        ______________________________________________

 

Address:                   ____________________________________________

 

                                    ____________________________________________

 

Phone Number:      ________________________

                         

Email address:        _______________________________________

 

Preferred method of contact:      ___ Email ___ Mail

 

Can we share this information with other members?          ___Yes ___No

 

Liability Release

I understand that participation in Buckeye Horse Pullers Assoc, of Ohio, Inc. could include actions or tasks which might be hazardous to the participant named above. By signing below, I assume any risk of harm or injury which might occur to the participant due to his/her/my participation in the event or activity. I release the Buckeye Horse Pullers Assoc. of Ohio, Inc. from all liability, costs and damages which might arise from participation in events. If the participant is a minor, I agree that the minor has my consent to participate in the event. I further provide my consent for the Buckeye Horse Pullers Assoc. of Ohio, Inc. to seek emergency treatment for the minor if necessary. I agree to accept all financial responsibility for the costs related to emergency treatment.

 

Signature of Participant____________________________ Date:_________

 

IF MEMBER IS A MINOR:

Signature of Parent of minor:________________________

Name of Parent of minor:________________________

Date:_________

FOR ASSOCIATION USE ONLY:

 

__Member Card Sent __/__/__  __Payment Method __/__/__    __Deposited __/__/__



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