~ Registration Form~ Dave Ellis ~ April 5,6 & 7, 2019

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1 ~ Registration Form~ Dave Ellis ~ April 5,6 & 7, 2019 Return clinic Registration, Release and Check Payable to: Cottonwood Creek Equestrian, Gail Bloxham, Evergreen Rd., Cottonwood, CA Name Address City State Zip Home Phone Work Phone Cell Phone How did you hear about this clinic: A $ non-refundable and non-transferable deposit to reserves your rider spot. Rider spots held verbally for 5 days. Payment in full must be received by March 5, 2019 See Fact Sheet for Additional Information Rider Positions:.~ $ Overnight Stall: ~$25.00 per night x (#) nights = Arrival date & approximate time Overnight Camping: No Hookups NO CHARGE in 2019, staying on site? _Yes No ********************************************************************** Auditor: Pre-Registered and Pre-Paid ~ $20.00 per day for days = (Day of Clinic ~ $30.00 per day) Please Bring A Chair Lunch available Auditor Name: TOTAL DUE *: *If paying by Credit Card, please add 3% to total due: Amount Paid Balance Due by March 5, 2019 If Paying By Credit Card Credit Card # CVC# EXP Date: Please check: VISA ( ) Mastercard ( ) *Must pay full amount when paying by credit card. Signature: 1

2 EQUINE ACTIVITY RELEASE & HOLD HARMLESS AGREEMENT COTTONWOOD CREEK EQUESTRIAN CENTER Evergreen Rd., Cottonwood, CA I, the undersigned have read and understand, and freely and voluntarily enter into this Release and Hold Harmless Agreement with Cottonwood Creek Equestrian Center (Company), understanding that this Release and Hold Harmless Agreement is a waiver of any and all liability(ies). 2. I understand the potential dangers that I could incur in mounting, riding, walking, boarding, jumping, feeding said horse; including, but not limited to, any interactions with other horses. Understanding those risks I hereby release that Company, its officers, directors, shareholders, employees and anyone else directly or indirectly connected with that Company from any liability whatsoever in the event of injury or damage of any nature (or perhaps even death) to me or anyone else caused by on incidental to me electing to mount and ride a horse owned or operated by Cottonwood Creek Equestrian Center. 3. I understand and recognize and warrant that this Release and Hold Harmless Agreement, is being voluntarily and intentionally signed and agreed to, and that in signing this Release and Hold Harmless Agreement I know and understand that this Release and Hold Harmless Agreement may further limit the liability of equine professionals to include any activity, whatsoever, involving an equine, including death, personal injury and/or damage to property. 4. I recognize and agree that I know which equine professional(s) I will be working with, and acknowledge that I agree said equine professional(s) has/have made reasonable and prudent efforts to determine my ability to engage in the equine activity, and has/have sufficient knowledge of my equine and horseback riding skills as to relieve, release and hold harmless said equine professional(s) from any continuing duty to monitor my equine activities. 5. I further voluntarily agree and warrant to Release and Hold Harmless this (these) equine professional(s) from any liability whatsoever, including, but not limited to, any incident caused by or related to said equine professional s(s ) negligence, relating to injuries known, unknown, or otherwise not herein disclosed; including, but not limited to, injuries, death or property damage from: mounting; riding; dismounting; walking; grooming; feeding; use of horse barn; use of arena; round corral, playground, paddock, trails or horse ring, in any capacity; falling off horse whether horse is bucking, flipping, spooked; or my failure to understand any equine professional s directions relating to my riding or otherwise use and control, or lack thereof, of my horse or the horse I have been assigned to. Person voluntarily entering into this Release and Hold Harmless Agreement Date: Name: Signature: Address: Phone: Parent or Guardian if above is under age 18: Age(if a minor) Parent s Name: Signature Address: Phone: 2

3 FEES: Clinic Fact Sheet - Cottonwood Creek Equestrian For additional information & questions contact: Gail Bloxham, Evergreen Rd., Cottonwood, CA cottonwoodck@aol.com Rider Positions: ~ $ ~Dave Ellis~ April 5, 6 & 7,019 Your deposit of $ reserves your rider spot. I will hold rider spots verbally - for 5 days. Payment in full must be received by March 5, Deposits are non-refundable. Cancellations: See Below Clinic Start Time: 9:00am to 4:30pm Rider Spots 10 maximum Auditor: Pre-Registered and Pre-Paid ~ $20.00 per day (Day of Clinic ~ $30.00 per day).. Please Bring A Chair Lunch available No refunds for cancellations or no shows. Overnight Stall Fees: Stall cost: ~ $25.00 per night. All stalls are matted and covered. Please provide your Arrival date & approximate arrival time. You are responsible for your own horse feed, clean, etc. Bring your own feed, bedding and water bucket. Shavings are available: $10.00 per bag Stall Cleaning is available: $10.00 per day Overnight Camping: NO CHARGE - Dry Camping only - no hookups. Call or cottonwoodcreekequest@gmail.com to reserve your spot! Checks payable to: Cottonwood Creek Equestrian Center (CCEC) 3

4 Clinic Format: A brief description: We ll take a look at the most popular competitions enjoyed by up & coming horsemen. We ll explore how our Natural Horsemanship flows into Cowboy Dressage. How Eitan s desire for lightness and softness fits right in our program. We ll work with our Parelli skills with the 5 elements of Ranch Versatility: Herd Work, Cow Work, Reining, Trail, Western Riding. This clinic is not about Cowboy Dressage, Ranch Versatility, Cutting, Reining, or any other actual competition. It s about how our Natural Horsemanship skills are used in these sports. It s about how regular folks can get and enjoy extraordinary results. Cancellations: All payments are non-refundable. If a rider or horse becomes unable to complete the clinic, no refund will be given and your deposit is forfeited as the Ride/Clinic host or instructor cannot be responsible for unforeseen problems. Video & Audiotaping: You are welcome to take pictures however Video & Audiotaping is not allowed. Horses: The State of California requires all horses entering the state to have a Negative Coggins within the last 12 months. This test takes some time, so if traveling from out of state, please plan ahead. Your horse should be healthy and in good shape. Horsekeeping: Please try to arrive before dark as it makes it easier to find your way around. The stalls are covered. Please bring your own water bucket, bedding and feed. You are responsible for cleaning your own stall daily and before you leave. If stalls are not clean upon departure you will be charged an additional $ Hay: If you need to purchase hay or shavings, the local feed store, Shasta Feed has hay and shavings available. Directions to Cottonwood Creek Equestrian Center Cottonwood is located between Redding & Red Bluff on Interstate 5. From I 5 Take Bowman Road exit (#662). Go West on Bowman Rd. for 3 miles. Turn Right on Evergreen Road. Go 1 mile. We are on the right Sign out front - you can see the covered arena from the road. Lunch & Breaks Coffee will be available in the morning. There will be a break for lunch, as well as through out the day. Tri Tip lunch, Chicken Caesar Salad or Chili are samples of what will be served along with drinks. Lunch is included for riders each day and Auditors are welcome to purchase lunch each day. 4

5 Lodging The following Motels are located within a short distance. GAIA Hotel & Spa (See link on our website for on line booking and corporate rate) 4125 Riverside Place Anderson, CA Best Western Knights Inn Motel Gateway Dr McMurry Dr. Anderson, Ca Anderson, Ca Baymont Inn & Suites Factory Outlets Dr. Anderson, CA Local Restaurants Shasta Branding Iron Woodside Grill (at the Gaia) Main St Riverside Pl. Cottonwood, Ca Anderson, CA Eagle s Nest Pizza Mary s Pizza, Anderson I-5 & Gas Point Road Puerto Vallarta, Anderson Cottonwood, CA RULES (Gotta have em ) Please drive VERY SLOWLY (12 miles per hr) while on the property. Our neighbors appreciate dust control! NO SMOKING or alcoholic beverages allowed on the premises. NO DOGS ALLOWED. We know how much you love your canine companions, but we would ask that you please refrain from bringing them to the Clinic. We wish to minimize any risk to people or horses that could be caused by an untimely bark or even just the normal doggy scampering. Thank you for your consideration of the riders, and their horses. Please pick up after yourself and your horse. There are trash receptacles and wheel barrels for manure. Manure management appreciates your help. Smile BE READY TO LEARN A TON AND HAVE LOTS OF FUN!!! 5