THE HOME FELLOWSHIP    4149 FM 2988, Navasota, Texas 77868

Phone 936/825-8414 FAX 936/825-8415
Website:www.thehomefellowship.org      Saturday, October 27, 2007

NAME:    ____________________________________________________________________________________

ADDRESS: __________________________________________________________________________________

CITY/STATE/ZIP:   ____________________________________________________________________________

PHONE:  HOME (      )___________________________________    MOBILE (      )     _______________________

WORK (      )___________________________________                           FAX (      )_________________________

E-MAIL: ______________________________________         BIRTH DATE: ________________AGE: _________

TRAIL RIDE FEE

ADULT                                              $20.00                            $ __________
12<CHILD ( yrs)                               $15.00                            $ __________

Play Day Activity
            Playday activities can be        $3.00 per activity               $ __________
            viewed on the website    

                                                                        TOTAL              $__________

PAYABLE TO:  The Home Fellowship
                             4149 FM 2988
                             Navasota, Texas 77868

CONTACT EMAILS:      Greg Vaughan                                                                    Robert Haferkamp
                                        gregsvon@gmail.com                                               allennavasota@aol.com   

 MUST BE COMPLETED¾• • • • • • • • • •                 2007 RELEASE  & SIGNED                       • • • • • • • • • • 
For and in consideration of the privilege of participating in and as a condition for participation in the 2007 HomeFellowship-Bibles and Bridles Fall Trail Ride, I hereby assume all risk of personal injury or damage to me, my property, and my livestock, and I hereby release, indemnify, and hold harmless The HomeFellowship, Michael Havens, and any entity or owner of the property upon which the Trail ride will occur. This extends to officers and individual members thereof, ride management, all ride personnel and Staff from any and all claims and/or liability from any accident, injury, damage or loss incurred or suffered by me or anyone in my charge or care no matter what the nature or cause.  I further agree to indemnify and hold harmless the aforementioned from any and all damages, costs, charges, expenses, legal fees or any other loss or expense incurred by said organizations or the individuals connected thereto resulting from any accident, injury, damage or loss incurred or suffered by any  third party resulting from any acts or actions on my part or by  anyone in my charge, whether such acts were intentional, accidental or negligent which caused or contributed to the cause of such accident, injury, damage or loss incurred or suffered by such third party. I do hereby certify that I have read the foregoing and agree to same and further agree to abide by all of the rules and regulations of the Trail Ride and state that I am qualified for participating therein.

WARNING: Under the Texas Law (Chapter 87, Civil Practice and Remedies Code) an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities.

NOTE:  Bring ORIGINAL Coggins papers for registration.

UNDER 18 YRS OLD (Print Name): PARTICIPANT  _____________________________________________       

 AGE (As of March 2, 2007):      ______________________________ BIRTH DATE: __________________________   

NAME OF PARENT/GUARDIAN:     ___________________________ PHONE: (       )_________________________

ADULT ACCOMPANYING MINOR: _________________________________________ PHONE: (       )__________________ 
 Participants under 18 years of age must be accompanied by an adult, and must have a release signed by parent or guardian.

PARTICIPANT 18 YRS & OLDER (Print Name): ____________________________________________________________   

SIGNATURE: _______________________________________________________________ DATE:     ________________         (Every participant, or parent/guardian of a minor participant, must sign a release form.)