William Clark Chamberlin Equestrian Center (WCCEC)
P.O. Box 112195 (3900 Abbott Road) Anchorage, AK 99511 907-522-1552

2008 Membership Application

 
New Member         Renewal
 
       
Name: 
  
     
Address: 
  
     
Phone: 
 Cell  
     
Email: 
  
Confirm  Email: 
  
     
Primary  Discipline: 
      Other:
       
Additional Family Members Living at Above Address (includes one additional adult and all youth under 18)
  First Name Last Name    
Name: 
Adult Minor
Name: 
Adult Minor
Name: 
Adult Minor
     
Family  Physician: 
Phone:  
       
Membership Type/Fee:
       
Family (Unrestricted membership for all riders in one household) $200.00
Individual (Unrestricted membership for one rider) $100.00
Trainer* (All trainers/instructors/coaches using WCCEC for lessons, etc.) Base + $175.00
Day Fee (One-time use. Release of liability must be signed) $15.00
Contribution
Please consider a donation along with your dues to support equestrian activities. Donate:
   Other:
       
*All individuals collecting remuneration (monetary or otherwise) to train/instruct/coach must upgrade individual or family base membership to "Trainer Status” and are required to provide written proof of insurance. No exceptions. For further details see 2007 WCCEC Facility Information and Rates. Current and negative EIAs are required for all horses on grounds.
       
Responsibility Waiver and Release of Liability
       

I am the participant listed below, or the parent/guardian of a minor participant listed below, who has my permission to use the William Clark Chamberlin Equestrian Center (“the facility”). I understand and agree that the risk of personal injury, property damage, death, or other loss of any nature whatsoever regardless of cause, while using the facility, or riding animals at the facility, is assumed by the participant, recognizing that horse sports may be dangerous and hazardous endeavors, even leading to permanent injury or death.

 

I also understand and agree that I will be solely responsible for the acts or behavior of any animal which I or any minor child of mine ride or which may be under my control or handling, and I agree to indemnify, hold harmless and defend the William Clark Chamberlin Equestrian Center, the Anchorage Horse Council, Inc. and the Municipality of Anchorage, their employees, agents, and representatives from and against any and all claims, demands, causes of action or losses of any kind whatsoever by the animal I ride or the animal under my control and/or handling.

 

In an emergency situation and if I am otherwise unable to authorize medical care, I hereby authorize medical care by either my family doctor or a licensed medical physician available to the William Clark Chamberlin Equestrian Center.

       
Adult Participant Adult Participant
       
Minor Parent/Guardian
       
Minor Parent/Guardian
       
       
I have read and understand the statements above and I will abide by all WCCEC 2007 Rules and Requirements.