GEAUGA HORSE & PONY ASSOCIATION

MEMBERSHIP APPLICATION 2022

** ATTENTION: TO STABLE WITH GHPA AT FAIR, YOUTH MUST BE A GHPA MEMBER BY MAY 1ST

Primary Member Name *

Name (of parent if a youth -18 yrs and under)

Street Address *

City *

State *

Zip Code *

Phone Number *

Phone Number (of parent of youth - 18 yrs and under)

Email Address (youth/adult) *

Email Address (of parent of youth - 18 yrs and under)

GHPA Youth Club Member (which?)

Membership *

New

Renewal

Youth & Adult Individual Memberships:

If received by May 1, 2022 ($25.00)

If received after May 1, 2022 ($35.00)

---- OR -----

Family Membership (includes husband, wife and youth 18 & under):

If received by May 1, 2022 ($35.00)

If received after May 1, 2022 ($45.00)

Approval to release information to Big Dee's Tack and Schneider's Saddlery? (Big Dee's reimburses club 5% on member's purchases, and Schneider's Saddlery gives 10% discount on most items when current membership card is presented) *

Yes, I approve

No, I do not approve

LIST THE NAMES OF ALL MEMBER(S) BELOW. All members must be listed for points to count. If a family membership, also list spouse's name. IMPORTANT: Members must sign in on volunteer log book before completing work hours (8 hours for individual memberships, 16 hours max. for family membership with 8 per member on the family membership) to be eligible for year end points. Refer to Rules and Regulations for complete list of eligibility rules:

Family Member 1 Name *

Family Member 1 Birthday (MM/DD/YYYY) * +

Family Member 2 Name

Family Member 2 Birthday (MM/DD/YYYY) +

Family Member 3 Name

Family Member 3 Birthday (MM/DD/YYYY) +

Family Member 4 Name

Family Member 4 Birthday (MM/DD/YYYY) +

The participant(s) agree(s) to indemnify and save harmless the Geauga Horse & Pony Association and the Geauga County Agricultural Society from and against all losses, liability or damage for injuries to persons or property, sustained on said premises and/or activities and from all loss, liability for damage by reason of Participant activities. An inherent risk of an equine activity as described under the Equine Liability Act is as follows: The propensity of an equine to behave in ways that may result in injury, death or loss to person on or around the equine, the unpredictability of an equine's reaction to sounds ,sudden movement unfamiliar objects, persons or other animals; hazards including, but not limited to, surface or sub-surface conditions, a collision with another equine, another animal, a person or an object; the potential of an equine activity participant to act in a negligent manner that may contribute to injury, death, or loss to the person of the participant or ,other person, including, but not limited to, failing to maintain control over an equine or failing to act within the ability of the participant. *

Yes I agree to the above statement (by selecting you are digitally agreeing to the above statement)

Date * +

Current Total:

$0.00