Instructions for Rally Release

FIRST PAGE:

1. Name of Rider at the top of the page
2. “Activity/Rally” = leave blank
3. (date) =  leave blank
4. (location) =  leave blank
5. Signature of Rider ONLY IF RIDER IS 18 OR OLDER. 
6. Signature of one Parent. 

7. If you own a horse, fill out the Equine Release section.  Horse's name must match your Coggins so have both Show name and barn nickname entered on there by the vet. Leave dates blank   

SECOND PAGE:

1. Name of rider and phone number with area code.

2. Address, including city, state and zip.
3. Rider's date of birth.

4. Rider's age as of Jan.1 of the relevant year (if filling out in the fall, use age as of 1/1 of

      the coming year of competition)

5. Rider's rating level for Quiz or Rally.  New testings for Rally must be completed by the end of April.  Leave blank if unsure and we will complete later.

6. Email address for a PARENT, not the rider.  Please print very clearly.

7. Cell numbers of both parents, if applicable.
8. Region = Midsouth
9. Breed = "Mix" if not a purebred
10. Name of Pony Club = Covered Bridge

A list of different Rallies follows.  Leave blank - we will complete.

Go the line just under “Quiz” Rally: 

1. “The above info is correct for ___________” -  leave blank.
2. Next line down = Rider signature.  
3. Next line down = Fill in Rider name.
4. Next line down = one Parent signature.  
5. Bottom of page = Rider signature  AND  Parent signature.  

*Please check that there are two rider and two parent signatures on this page.

            For problems or questions regarding this web contact Peggi Bindner

Last updated: 01/22/08.