EmailMe Form - Little Mitten Plastic Classic Entry Form

Shower Name

First Last

Shower Initials on Tags

Address

Street Address City State / Province / Region Postal / Zip Code

Email

Phone

### - ### - ####

Guest?

I am not bringing a guest

I am bringing a guest

Guest Name

First Last

First Table Choice:

Card table ($45)

High Top table ($45)

Second Table Choice (some of these sizes have been reserved, wait list available):

I would like to sit next to a friend (enter name).

Approximately how many models will you be bringing?

Under 25

25 to 50

More than 50

What divisions will you most likely be showing in?

Mentor Program

I am a new shower or haven't shown in a while and I would like to sit next to an experienced mentor shower.

I am an experienced shower and I would like to mentor another shower.

Little Mitten Plastic Classic 2022 Waiver of Liability and Release

I have been informed and fully realize there are dangers and risks to which I may be exposed while participating in the Model Horse Show. These risks may include the possibility of bodily injury, or death, from hazards including but not limited to slips or falls or other damage to my person, illness, and/or damage to my property while participating in this activity.

I, therefore, freely and voluntarily agree to assume and take on myself all of the risks and responsibilities in any way associated with this activity. I release Sarah Tregay, Ann Guldemond, the First Presbyterian Church of Mount Clemens its employees, and agents from all liability, claims, and actions that may arise from injury or harm to me, from my death, or from damage to my property in connection with this activity. I understand that this Release covers liability, claims, and actions caused entirely or in part by any acts or failures to act of Sarah Tregay, Ann Guldemond, the First Presbyterian Church of Mount Clemens, or any of its employees
or agents, including but not limited to negligence, mistake, or failure to supervise.

I understand that this Release does not apply to instances of intentional misconduct by a host, employee or agent.

I know that if I become ill or injured while participating in this activity, I am responsible for my health care expenses and I have made arrangements to handle such expenses through insurance coverage, access to cash, or other methods.

I assume full responsibility for any and all claims and costs arising directly or indirectly from any of my activities, acts, or omissions while participating in this activity.

I further release Sarah Tregay, Ann Guldemond, the First Presbyterian Church of Mount Clemens its employees, and agents from liability for any claim of loss, injury, or damage to me or my property due to any act, omission, or negligence of parties not an host, agent or employee, including, but not limited to, other showers and guests.

These releases are effective for me, my personal representative, assigns, and heirs.

I HAVE CAREFULLY READ AND UNDERSTAND COMPLETELY THE ABOVE PROVISIONS, AND VOLUNTARILY SIGN THIS RELEASE.
(Type Name)

Type Signature of Parent/Guardian of minor

Date Time

MM / DD / YYYY