Nadeem Noon Clinic March 23 & 24, 2013

Rolling Hills Equestrian Center 7088 Old Corydon Road Henderson, KY 42420
Rolling Hills Equestrian Center is proud to host Nadeem Noon, an accomplished competitor and well known trainer and clinician in Bloomington, IN. With over 30 years of teaching experience in dressage, show jumping and XC, Nad has earned both a British Horse Society Instructor Certification and the USEA ICP Level 3 Instructor Certification. Currently the head coach for the Indiana University Equestrian Team, he was National Show Jumping Champion in his home country of Pakistan and later represented them at the 3-star level in eventing in the US, qualifying for the World Cup Championships in Malmo, Sweden. Nad has coached upper level event riders to the 2-star, 3-star, and 4-star levels as well as riding and coaching through the Prix St. George level in dressage. Closing Date: Saturday, March 16, 2013. Entries must be in hand as of this date. Coggins: Current coggins for all horses on the grounds must be submitted with entry form Health Certificate: A health certificate is required for transport of all horses into and within the state of Kentucky; check with your vet for details. Please have on hand at clinic or submit with entry. Stabling: Limited stabling/ turnout available. Please contact Brian Godwin at 270-454-4490 for information. Attire: ASTM approved helmets and boots with heel required for ALL riders while mounted. Ride Times/ Groups: Will be emailed to the address provided by Wednesday, March 20, 2013 Clinic Fees Dressage or Jumping lessons offered, please indicate preference on entry Private lesson 45 minutes - $90 ($70 USPC or LTD member) Semi-private lesson (2 people) 45 minutes - $55 p/p ($40 USPC or LTD member) Group lesson (3-4 people) 1.5 hours - $65 p/p ($50 USPC or LTD member) Name ________________________________________ Age ________ Telephone ______________________ Email ________________________________________ USPC Member? ________ LTD Member? _________ Address _______________________________ City ________________________ State ______ Zip ________ Horses Name __________________________ Age _______ Breed ____________________ Height _______ Please circle or highlight the following as applicable: Eventing Dresssage Horses highest level competed? Never BN N T P+ Never Intro Trg 1st 2nd 3rd+ Horses highest level schooled XC Never BN N T P+ Riders highest level competed? Never BN N T P+ Never Intro Trg 1st 2nd 3rd+ Horse & Rider currently competing at? Never BN N T P+ Never Intro Trg 1st 2nd 3rd+ Horses maximum or comfortable jumping height? 2 26 3 33 37+ Riders maximum or comfortable jumping height? 2 26 3 33 37+ Horse and rider need work on _________________________________________________________________ Additional information to help place you in an appropriate group, suggestions and expectations for this clinic

BE SURE TO FULLY COMPLETE, SIGN, AND ENCLOSE ENTRY FORM, LIABILITY RELEASE FORM, MEDICAL RELEASE FORM, COGGINS, AND CHECK.

Please choose one session per horse per day. 45 Min Private $90 / $70

Saturday, March 23, 2013 Indicate Name lesson Dressage or partner or group Jumping members, if known

Enter fee

Sunday, March 24, 2013 Indicate Name lesson Dressage or partner or group Enter Jumping members, if known fee

45 Min Semi-Private $55 p/p | $40 p/p

90 Min Group $65 p/p | $50 p/p Total Fees

Checks made payable to: Shannon Murphy. Mail completed form, copy of negative coggins, medical release form for minors, and checks to: Shannon Murphy, 1483 Kayak Lane, Henderson, KY 42420 Entries also accepted in person up to closing date at Rolling Hills Equestrian Center, 7088 Old Corydon Road, Henderson, KY 42420. Contact Shannon at (205) 482-3302 to arrange.
WARNING: Under Kentucky law, a farm animal activity sponsor, farm animal professional, or other person does not the duty to eliminate all risks of injury of participation in farm animal activities. There are inherent risks of injury that you voluntarily accept if you participate in farm animal activities.

Failure to comply with the requirements concerning warning signs and notices provided in this section shall prevent a farm animal activity sponsor or farm animal professional from invoking the provisions of KRS247.401 to 247.4029.

Nothing in KRS 247.402 to 247.2049 shall create a duty for a farm animal activity sponsor, farm animal professional, or other person to give a warning to a participant engaged in a farm animal activity with his own farm animal, or to a participant whom the farm animal activity, farm animal professional or other person knows to possess reasonable knowledge of or experience with the inherent risk of farm animal activities, or who has represented to the farm animal activity sponsor, farm animal professional, or other person that he possesses reasonable knowledge or experience with the inherent risks of farm animal activities.

I understand that riding/showing horses is a high risk sport and I am participating (or allowing my child to participate) at my (his/her) own risk. I hereby assume this risk and release and hold harmless Rolling Hills Equestrian Center, Nadeem Noon, clinic management, volunteers, farm staff, judges and officials from all liability for negligence resulting in accidents, death, damage, injury or illness to myself, my horse(s) or to my property during the above show.

Signature (Parent/Guardian if a minor):

Date:

EMERGENCY MEDICAL RELEASE FORM To be submitted by all participants under the age of 21

If emergency medical care is required for _______________________________ (participant) in conjunction with the Nadeem Noon/ RHEC clinic, and if normal permission is not available in a timely manner, the undersigned authorizes appropriate medical care as deemed necessary by emergency medical personnel, a physician, or the medical facility providing treatment. RELATED INFORMATION: Parent or Guardian: _________________________________________________________________________ Address: ___________________________________ City: ______________________ State: ____ Zip:______ Telephone: (Home) ________________________________ (Work) __________________________________ If Parent or Guardian is unavailable, contact: _____________________________________________________ Telephone: ___________________________ Family Physician: _______________________________ Telephone: _________________________________ Participant is allergic to: _____________________________________________________________________ Participant takes the following medication(s): ____________________________________________________ _______________________________ for: ______________________________________________________ Participants Date of Birth: __________________________ (MM/DD/YYYY) Medical Insurance Company: _________________________________ Policy Number(s): ________________ I HAVE READ THIS RELEASE AND AGREE TO IT: Signed: ___________________________________________ Date: _________________________________ Signature of Parent or Guardian As Parent or Guardian of the above named participant, I ask that every effort be made to contact me at the time of the accident or illness.