Name______________________________

Address________________________City___________St_______Zip__________

Phone____________________email____________________________________

Registered Horse Name ______________________________________________

Barn Name_________________________________________________________

Color____________________Markings______________________________

Brands or scars__________________________________________________

Nomination

To the best of my knowledge the above horse has never ran in the 1D or 2D in any open 4 or 5D Barrel race. I verify that this horse qualifies for the Medals Class and understand that if for any reason there is proof that this horse does not qualify then all monies won will be refunded to PBHA and all entry fees will be forfeited. The PBHA directors will have the last say in this matter and all non compliance issues should be directed to the board of Directors.

Signed______________________________________________________________Date___________________

Release of Liability

I do hereby declare that I am a participant or legal custodial parent of guardian of my child or ward participating in this event. I hereby agree to comply with all rules and regulations of the arena, producers and sponsors. For myself, my executors, heirs, next of kin, administrators, successors and assigns, I hereby waive and release all claims that I may have against the Pacific Barrel Horse Association and co-sanctioning organizations, it’s officers, members, volunteers, sponsors, facility owners including any and all claims for damage caused by negligence of any of them, arising out of my participation in this event and it’s related activities. I further agree to indemnify, release, hold harmless and defend the Pacific Barrel Horse Association and co-sanctioning organizations, its officers, volunteers, sponsors and arena owners against any and all claims of injury or damage to persons or property. I understand that horses and activities involving horses can cause serious injury or death. I hereby acknowledge that participation in this event carries potential hazard, I therefore release the Pacific Barrel Horse Association and co-sanctioning organizations, its officers, members, volunteers, sponsors and facility owners of any liability resulting from injury or death during this event or related activity. This release is perpetual for the 2007 season ending 12/31/07.

Signed______________________________________________________Date_______________________

(Any one under 18 must have a parent or legal guardian sign)

Signature of Parent or legal guardian______________________________Date_______________________