THIS IS NOT AN ON-LINE SUBMISSION FORM-PLEASE PRINT THIS FORM OUT AND BRING WITH YOU!
TRIANGLE CROSS BARREL RACING – KIPLINGER ARENA – McCOOK NE
2009/2010 WINTER CRUMINE BUCKLE SERIES
(NE4D, BBR & Mile Hi affiliate co-approved - 2nd race is not BBR or NE4D)
FIRST OPEN RACE
Please use registered names!
| Horse 1 | Open Fee $25 | ||
| Horse 2 | Open Fee $25 | ||
| Horse 3 | Open Fee $25 | ||
| # Exh x $3 |
NOVICE CLASS (may roll time from 1st open to novice)
| Horse 1 | Novice Fee $15 | "x" if roll from open | |
| Horse 1 | Novice Fee $15 | "x" if roll from open |
SECOND OPEN RACE (you may roll your time from 1st race or novice or both)
| Horse 1 | Open Fee $25 | "x" if roll from | |
| Horse 2 | Open Fee $25 | "x" if roll from | |
| Horse 3 | Open Fee $25 | "x" if roll from | |
| # Exh x $3 | |||
| BARN FEE $5 / HORSE -- | |||
| TOTAL FEES: |
| Name: | |
| Address: | |
| City, State, Zip | |
| Phone#: | |
| Email: | |
| BBR # |
____________________________________________________ _______________
Signature (parent or guardian if under 18) Date
Nebraska law provides that an equine activity sponsor, an equine professional, or any other person shall not be liable for an injury to or the death of a participant re
sulting from the inherent risks of equine activities and no participant shall make any claim against,
maintain an action against, or recover from an equine activity sponsor. NE ST § 25-21,249 - 253