Davidson County Horsemen's Association/R.E.I.N.S  Membership Application

Name:  ____________________________________________________    Date: ___________________

Address: ____________________________________________________________

City:  _______________________________  State: ________   Zip: _____________

Phone:  __________________  E-Mail:  ____________________________________

Number of Horses Owned:  _________       Type of Horse Owner:     _____  Professional Trainer    _____  For Pleasure Only

                                                                                                                  _____  Boarding Stables           _____  Breeding

                                                             Other: (Describe)_______________________________________________________________

Horse Activities:

 _____  Trail Ride   _____  Show Horses   _____  Other: (Describe)____________________________________________________

 Select A Membership Plan:

_____  Family - $25.00                          _____  Individual - $15.00

_____  Youth (Under 17 yrs) - $5.00   _____  4-H Youth - Free - Name of Counselor: _____________________________________

 RELEASE FROM LIABILITY

 I, the undersigned, hereby apply for membership in the Davidson County Horsemen's Association/R.E.I.N.S. (DCHA/REINS) and agree to abide by its rules for association and activities. I acknowledge that horseback riding is a sport, which carries inherent risks of injury and damage to myself, my horse and property. I knowingly assume all risks, whether known or unknown, of horseback riding. I hereby release DCHA/REINS, its directors, officers, agents, helpers and members from all liability for any act of negligence or want of ordinary care on their part. In consideration of my participation in activities organized or sponsored by the DCHA/REINS, I hereby wave and discharge the DCHA/REINS, its directors, officers, agents, helpers and members against all claims of liability for illness, injury or damage to myself, other members of my family, riders of my horse, my animals, or my property arising out of my participation. I acknowledge that I have read this RELEASE FROM LIABILITY and know and understand its contents.

 SIGNATURE OF APPLICANTS:

 Member:  ____________________________________________________________  Date: __________________

 Spouse:  ____________________________________________________________   Date: __________________

 RELEASE FROM LIABILITY BY PARENT OR LEGAL GUARDIAN  (For children under the age of 18)

  Child(ren)'s Names(s):  ______________________________________________________________________________________

   _________________________________________________________________________________________________________

   _________________________________________________________________________________________________________

 I, the undersigned parent or guardian of the above named member(s), agree to the above and additionally and specifically agree that the terms and conditions of this RELEASE FROM LIABILITY shall be binding as to damage or injury to my minor, his or her animals, and property that may occur as a result of Association activities.

 SIGNATURE OF PARENT OR LEGAL GUARDIAN: _______________________________________________________

                                                                          DATE: ______________

 Make Checks Payable to DAVIDSON COUNTY HORSEMEN'S ASSOCIATION/R.E.I.N.S

 Print this form, fill it out and mail this Application along with your payment to:

          Davidson County Horsemen's Association/R.E.I.N.S

           Po Box 519

          Lexington, NC  27293