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I have applied to participate in this USEA sponsored educational activity. I agree that my participation is subject to the Conditions in this release and to those set by the organizer of this activity, the regulations and requirements of the USEA and, where applicable, the U.S. Equestrian Federation Rules for Eventing.

I agree to wear personal protective equipment when participating in this educational activity. When riding and handling equine, I agree to wear protective headgear passing or surpassing the ASTM/SEI standards with harness attached that meets standards currently imposed by the U.S. Equestrian Rules for Eventing. I understand that the USEA mandates that all riders participating in cross-country activity wear body-protecting vests that meet or exceed current USEF rules and the wearing of an approved medical armband or bracelet.

I understand that the sport of eventing is a high risk sport, and that my participation in this educational activity may also involve participation in an “equine activity” as defined by applicable laws and is solely at my own risk. I understand that my participation involves all inherent risks associated with the dangers and conditions which are an integral part of equine activities, including, but not limited to, the propensity of equines to behave in ways which may result in injury, harm or even death to humans or other animals around or near them; the unpredictability of equine reaction to sounds, sudden movements, smells and unfamiliar objects; persons or other animals; hazards related to surface and subsurface conditions; collisions with other equines or objects; sickness and disease (including communicable diseases); and, the potential of a participant to act in a negligent or unskilled manner which may contribute to injury to the participant or others, including failing or inability to maintain control over the animal. By participating in this activity I agree to assume responsibility for those risks, and I release and agree to hold harmless the activity organizer, organizing committee, officials, the USEA, USEF, their officers, agents, employees and the volunteers assisting in the conduct of this USEA educational activity and the owners of any property on which it is to be held, from all liability for negligence resulting in accidents, damage, injury or illness to myself and to my property, including the horse(s) which I may ride.

I understand and agree that the organizer of this USEA educational activity has the right to cancel this activity; to refuse any entry or application; to require and enforce the wearing of safety or other attire and the conduct of riders, horses and visitors; and to prohibit, stop or control any action during the activity deemed by the organizer to be improper or unsafe.

THIS FORM MUST BE FILLED OUT COMPLETELY AND SIGNED IF YOU WISH TO PARTICIPATE IN THIS ACTIVITY.

Mid America Eventing Association
Heritage Park XC Schooling and Schooling Show Release

Fees:      $40 for MACTA members
              $60 for NON-MACTA member (includes a one day membership fee)

Boots with heels, helmets with chin harness, protective vests and medical armbands must be worn and are REQUIRED whenever mounted.

Warning
Inherent Risk of Domestic Animal Activities

Under Kansas law, there is no liability for an injury to or the death of a participant in domestic animal activities resulting from the inherent risks of domestic animal activities, pursuant to K.S.A. 60-4001 through 60-4004.  You are assuming the risk of participating in this domestic animal activity.  Inherent risks of domestic animal activities include, but shall not be limited to:

  1. The propensity of a domestic animal to behave in ways, i.e. running, bucking, biting, kicking, shying, stumbling, rearing, falling, or stepping on that may result in death of persons on or around them;
  2. The unpredictability of domestic animal’s reaction to such things as sounds, sudden movement of unfamiliar objects, persons or other animals;
  3. Certain hazards such as surface and subsurface conditions;
  4. Collisions with other animals or objects; and
  5. The potential danger of participant to act in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the domestic animal or not acting within such participant’s ability.

I have read the above warning statement and understand the nature of the inherent risks of this domestic animal activity (“Activity”).  I also understand and have been fully made aware that this is a high-risk sport that could result in catastrophic injury, paralysis and death and further understand that I am participating at my own risk.  If at any time I believe or suspect that the conditions at the premises are hazardous or unsafe I will immediately cease all further participation in the Activity.  I hereby accept and assume all risks associated with my participation in the Activity and further accept and assume all responsibility, financial and otherwise, for any losses, costs or damages arising out of my participation in the Activity.

In consideration of my participation in the Activity, I hereby release, discharge, covenant not to sue, and agree to indemnify and hold harmless the Mid-America Combined Training Association (MACTA), MACTA volunteers, Johnson County Parks and Recreation District, Johnson County, and the City of Olathe and its employees (the Releasees),  from any liability, claims, losses or damages arising out of, or in any way connected with, my participation in the Activity, including those caused, or alleged to be caused, in whole or in part, by the acts or omissions of any of the Releasees from any and all litigation expenses, attorneys fees, losses, damages or judgments arising out of any claim based on, or in any way related to, my participation in the Activity that result in accidents, damage, injury or illness to myself and to my property, including the horse or horses which I ride.

Today's date: May 5, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
If participant is under 18, Release must be signed by parent or legal guardian, not by trainer or instructor. This release form is valid only when signed personally by the participant. Signatures of all others, with the exception of a parent or legal guardian of a minor, will not be accepted in the event a claim is filed.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

NAME OF ACTIVITY/SCHOOLING SHOW:

USEA AREA:

DATE(S) HELD: *

LOCATION:

STATE:

TRAINER'S NAME (AT THIS EVENT):

NUMBER OF HORSES I WILL BE RIDING DURING ACTIVITY (if applicable):
Current Riding Level (if applicable):
Check appropriate box:
I am a USEA member
I am not a USEA member
I am not a USEA member. I wish to join and have enclosed my membership form and dues.

If USEA member, my number is:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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