Competition: CICW, CIC and EFA One Day Event - Warwick Date: 26^th and 27^th July

Name of Rider: Rider EFA/FEI No: Country/State where registered:

Address: PCode: PhoneNo: Fax No: Email:

ACKNOWLEDGMENT AND INDEMNITY.

I, _______________________________________________declare that the above information is true and correct. I also agree to abide by the Rules and Regulations set down for the conduct of official events as per those declared by the Federation Equestre Internationale (FEI) and the Equestrian Federation of Australia Queensland Branch (EFAQ).

As a condition of my entry into the above mentioned competition I hereby acknowledge that I ride at my own risk and that I am aware that activities involving horses can be hazardous and that the EFAQ accepts no responsibility or liability for any injury or loss that I might sustain as a direct or indirect consequence of the activities of the competition whether such injury is a consequence of any act or omission by the EFAQ or its servants, agents, representatives, or volunteers. On the basis of these conditions I hereby indemnify them against all liability (including liability for their negligence, my negligence and the negligence of others) for all injury, loss or damage (including property damage) arising out of or in connection with my participation in this event to the fullest extent permitted by law but only to the extent that they are not already indemnified or insured.

I declare that my horse, my saddlery and myself in sound condition and undertake this competition with knowledge of the physical demands that this competition requires.

I consent to receiving any medical treatment, including ambulance transportation that the event organisers think desirable during or after the event. I acknowledge that the safety precautions undertaken by the event organisers (such as course inspection, pre-event safety briefings) are a service to me and other competitors but are not a guarantee of safety.

I certify that I am 18 years or older and 1 have read this document and fully understand it.

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PARENT / GUARDIAN (SIGNATURE) DATE:

NATIONAL FEDERATION APPROVAL for CIC*. By signing, the NF of the rider above, confirms that the rider and the horse (s) are duly qualified as per the attached qualification form or competent to compete CIC* for this event as per the applicable Rules.