THE HIGHWAY 50 ASSOCIATION 60th ANNUAL WAGON TRAIN June 6 through June 14, 2009 Zephyr Cove, Nevada to Placerville, California |
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REGISTRATION FORM
NOTE: Do NOT mail registration forms after May 23rd, 2009. Between May 23rd and June 5th, please call Vi Tara (530) 644-3761 for more information. After June 5th, bring your form personally to a wagon train stop. No day registrations will be accepted after 8:00 p.m. on Saturday, June 14th, 2009, at High Hill Ranch, Camino, California. I WISH TO PARTICIPATE AS: (Please check appropriate boxes) ONE FORM PER PARTICIPANT, PLEASE!
NAME:___________________________________________
PHONE #:(___) __________________ CITY________________________________ STATE___________________ ZIP ________________
PLUS:
WAGON OWNERS NOTE: Wagon and Teamster registration free. Spouse, children under age 18 living in same household $30/ea. - entire trip. Separate registration form for each participant.
As a Participant in the 2009 Wagon Train, I agree to abide by all the directives of the Wagon Master or her assigned representatives. I have read the RULES OF THE ROAD, and by affixing my signature below, agree to abide by those Rules. In consideration for the Highway 50 Association permitting me to participate in the Wagon Train hereinafter described, I, ___________________________________________, Herby absolve the Highway 50 Association from any responsibility or liability during the 2009 Wagon Train, originating at Zephyr Cove, Nevada on June 6th, 2009, and ending in Placerville, California, on June 14, 2009. I FURTHER AGREE TO INDEMINFY AND SAVE HARMLESS THE HIGHWAY 50 ASSOCIATION FROM ANY CLAIM FOR LOSS, DAMAGE, OR INJURY SUSTAINED BY ANY PERSON WHOMSOEVER, CAUSED BY MY NEGLIGENCE OR MISCONDUCT WHILE PARTICIPATING IN, OR PREPARING FOR THE ABOVE DESCRIBED WAGON TRAIN TREK. I acknowledge that circumstances may arise under which the said Association may elect to cancel the Wagon Train trek, and I hereby release and relinquish any right I may have to recover for damages, financial or otherwise, by virtue of such cancellation.
Do you have any medical conditions or allergies? |___| YES |___| NO NAME/PHONE # EMERGENCY CONTACT: ________________________________________________ FILL OUT ONLY IF YOU ARE NOT USING YOUR OWN HORSE I, _____________________________________ understand riding a horse can be dangerous and cause me serious injury or even death. I also understand that riding a horse I do not own is far more hazardous, therefore, I hold Highway 50 Association Wagon Train harmless for any injuries to myself or my personal property and accept full responsibility for any damage that may arise from using or renting a horse to use on Wagon Train 2009.
NOTE: Current Coggins Test and Health Certificates are required for ALL horses and mules. This is your responsibility. MINOR'S CLEARANCE In consideration for the Highway 50 Association permitting my/our minor child to participate in the 2009 Wagon Train, hereinbefore described, I/We ____________________________________________________ Consent to My/Our child participating in this 2009 Wagon Train Trek and for Ourselves, our heirs, administrators, and assigns, and for and on behalf absolve, waive, and release any and all claims against the Highway 50 Association or any of its representatives, their agents, for any and all injuries suffered by said minor, his/her animal, handlers of livestock belonging to him, or loss or damage of same while being used during this trek and celebration, which originates in Zephyr Cove, Nevada, Rendezvous time June 6th, 2009, until its subsequent disbandment June 14, 2009. Said
minor will be under the care and custody of I/We, parent or guardian of _________________________________________ (minor child) hereby designate the responsible adult aforementioned, and/or the Wagon Master of the Highway 50 Association, to authorize and obtain any emergency medical treatment from a duly licensed physician or hospital on behalf of My/Our child who is participating in the 2009 Highway 50 Association Wagon Train Trek, beginning June 6th, 2009, and to and Including June 14th, 2009. I declare under penalty of perjury that the foregoing is true and correct. Executed at:_____________________________________________________this________________day of ___________, 2009.
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