USPC Medical Release Instructions

      1)  DO NOT SIGN or date the forms yet.  See step 2 below.

 2)  Fill out one USPC Release Form with the information requested

(except for the signature lines at the top.)

• "Club No." is 080040

• "Club" is Covered Bridge Pony Club

•   "Region" is Midsouth

•  It is not necessary to include the second page or have a doctor’s signature unless you checked “Yes” in the “Existing Medical Questions” box at the bottom of Page 1.  

        3)  Make 6 copies; THEN sign and date the copies in BLUE ink.

                  Keep the unsigned original in case you need more.  

    *Note the parent signs twice unless the member is 18 yrs or older.

      Members 18 or older sign this form instead of the parent.   

Send along with either your New Member or Renewal papers. 

If you are joining for the first time, it is best to just bring an additional copy along to your first meeting in case they have not received a copy from us yet.  Remember to take a copy to each barn where you attend a meeting - only your "home" barn will be furnished with a copy.

Besides Pony Club meetings, the other copies will be used for competitor armbands at all rallies, entry packets for Quiz, Games, MegaRally (including C Advisors), Rally Camp (including C Advisors) & upper level testings.

        For problems or questions regarding this web contact Peggi Bindner

Last updated: 11/17/09.