Membership Forms

You may block and copy any of these forms and paste them into your word processor. Print them out, fill in and send to:

Manager: Great Meadow Polo Club, Inc. . 5089 Old Tavern Road . The Plains, Virginia 20198

Great Meadow Polo Club

2008 Membership Application


Members Name(s)		Date of Birth

Team Name	Team Colors

Street Address

City	State & Zip

Home Phone	Work Phone
Cell Phone	Fax

Email Address	Email Address

Membership Type	Dues	Quantity	Subtotal
Base* includes all stadium play	$1,000
League per Team per Month
Stadium	$400
4 Goal	$1,500
8 Goal	$2,000


	Grand Total

Members Signature

Date

Signature of Parent or Guardian of Junior Member (if under 18)			Date
Name

Area of Interest (Please check each league you are considering playing in)
0 Goal Stadium
0 Goal Grass
0-3 Goal Stadium
0-3 Goal Grass
*4-7 Goal Grass
*8 Goal Grass

*Depending upon interest. There may be additional dues associated with the 4-7 goal grass.

Member Bio: Please tell us a little about yourself. This information will be made part of our program. You may also email your bio to mailto:manager@greatmeadowpoloclub.com?subject=Bio no later than (May 1, 2005).

Favorite Horse Biography: Tell us a little about your favorite polo pony. Feel free to e-mail a photo for inclusion in the Program.

COVENANT NOT TO SUE

I, _____________________________________________, for myself, my legal representatives, and assigns, for and in consideration of the privilege of participating in activities sponsored by the Piedmont Polo Association dba Great Meadow Polo Club, (GMPC), hereby promises not to sue or make any claim against GMPC, the owner(s) and/or lessee(s) of record of any horses utilized by GMPC or any of its members in GMPC activities, the owner(s) and/or lessee(s) of any premises or equipment used by GMPC members, officers, and directors, and any assigns of the said members, officers, and directors due to any and all occurrences which may arise during the course of any polo practice, match, or tournament, or training, exercising, transport and/or loading of horse, and any other activity sanctioned by or in connection with GMPC or D-Barnes Polo dba Destination Polo. This Covenant not to Sue includes, but is not limited to, personal injury or death, property damage, and any other civil damage arising from the aforesaid activities. This Covenant not to Sue is perpetual in duration.

I further certify that I have read this "Covenant not to Sue" and understand that, by my signature hereon, I am giving up any and all rights I may have to sue or make a claim against any of the above described persons or entities at any time in the future. I further certify that I have been given ample opportunity to review this document and ask questions concerning it, and certify that I am signing this document freely and voluntarily and without duress from any source.

___________________________________

Signature and Date

___________________________________

Signature of parent or legal guardian

if participant is under 18

___________________________________

Date

___________________________________

Witness

2008

RELEASE AND WAIVER OF LIABILITY

PIEDMONT POLO ASSOCIATION

Dba GREAT MEADOW POLO CLUB

Operator is hereby defined as PIEDMONT POLO ASSOCIATION, (DBA) GREAT MEADOW POLO CLUB, an entity incorporated under the laws of Virginia, that leases and operates an equestrian facility hereby defined as the land and all equine-related improvements located at 5089 Old Tavern Road, The Plains, Virginia (the A facilities@ ), and its members, officers, directors, employees, agents, or independent contractors.

Landowner is defined herein as the Meadow Outdoors Foundation and its employees, trustees, agents or contractors. Landowners are the owners/lessors of the facilities.

Equine activities is hereby defined to include, but is not limited to: (i) equine shows, practices, lessons, pleasure riding, or performances of any kind (including any pony club activity), whether in an arena or in the fields; and (ii) polo, which is defined to include participating in the game of polo, playing polo matches or practices, A stick and balling,@ being a spectator, a polo player or student, polo trainer or teacher, polo attendant or groom, polo referee, umpire or judge.

Participant means any person, whether amateur or professional, who engages in an equine activity, whether or not a fee is paid to participate in the equine activity.

INSPECTION OF FACILITIES

Participant or participant’s parent or legal guardian agrees to inspect the facilities for suitability and safety, and if he/she believes anything is unsafe, he/she will immediately advise Operator= s representative of such conditions and refuse to participate or allow the minor child to participate.

PARTICIPANT’S FITNESS

Participant or participant= s parent or legal guardian verifies that he/she or the minor child is in good health and that he/she or the minor child has no physical limitations that would preclude safe participation in equine activities.

ASSUMPTION OF RISKS

Participant or participant= s parent or legal guardian hereby acknowledges the hazards and risks inherent in equine activities, including but not limited to (1) the propensity of an equine to behave in dangerous ways which may result in injury or death to participant, (2) the inability to predict any equine= s reaction to sound, movements, objects, persons, or animals, (3) hazards of surface or subsurface conditions, (4) hazards created by objects such as mallets, polo balls, loose leg wraps, jumps or games equipment, (5) the conduct of other players or participants, (6) ride-offs, (7) collisions between mounts, (8) collisions with a wall. These and other risks can result in serious injury or even death. Participant or participant= s parent or legal guardian hereby specifically assumes these and all risks, and the risk of acts or omissions that constitute negligence for the safety of the participant by Operator or Landowners, whether or not related to the preceding enumerated inherent risks.

Participant or participant's parent or legal guardian understands that polo helmets (available with face-guards) that have been safety rated can be purchased and that, for purposes of engaging in polo activities, such helmets are likely to be safer than typical riding helmets.

USPA MEMBERSHIP

In the case of a Participant who plays polo, Participant or participant’s parent or legal guardian confirm by signing below that the Participant is a member of the United States Polo Association.

AGREEMENT FOR RELEASE AND TO HOLD HARMLESS

In consideration of the participant being permitted to engage in equine activities at the facilities, the undersigned on behalf of participant and his or her heirs, next of kin, dependents, representatives, executors or administrators hereby does release, indemnify (including costs and attorney’s fees) and hold harmless the Operator and/or the Landowners from any cause of action, claims, demands or liability of any nature whatsoever, which said participant, his or her representatives, heirs, next of kin, dependents, executors or administrators, may now have, or have in the future, against said Operator or Landowners, on account of death, personal injury, property damage, or accident of any kind arising out of the participant= s participation in, or observation of, equine activities.

Participant or participant= s parent or legal guardian understands that by signing this Release and in consideration for the privilege to participate in equine activities at the facilities, he/she covenants and agrees that he/she, as well as his/her heirs, next of kin, representatives, dependents, executors, administrators, successors and assigns, will never institute any suit or action of law or otherwise against Operator and/or Landowners or in any way aid in the institution or prosecution of any claims, demand, action or cause of action for damages, costs, loss of services, expenses or compensation for or on account of any damage, loss or injury either to his person, property, or the person or property of such minor child which may result from the participant= s attendance at and/or participation in equine activities.

THIS RELEASE SHALL REMAIN IN EFFECT UNTIL EXPRESSLY REVOKED IN WRITING BY THE PARTICIPANT OR PARENT OR GUARDIAN, WITH RECEIPT ACKNOWLEDGED BY THE OPERATOR’S REPRESENTATIVE.

Participant states that he/she is of lawful age and legally competent to sign this release which he/she has fully read, completely understands, and agrees with its terms. Participant understands the terms are contractual and not a mere recital, and that he/she has signed this document of his/her own free will.

________________________________
Date Signature of Participant (if 18 years old or older)

_______________________________
Print name of Participant

I am the parent or legal guardian of ______________________________, a minor. I have fully read, understand and agree with the terms of this release. On the minor= s behalf and on my behalf and on the behalf of all other parents or guardians of the minor, I execute the foregoing release and waiver of liability as an inducement for my child, or this minor, being allowed to participate in equine activities at the facilities and warrant that I have the authority to give this release and I completely understand that its terms are contractual and not merely a recital.

______________________________
Date Signature of parent or legal guardian

______________________________
Print name of parent or guardian

______________________________
Relationship to participant

Great Meadow Polo Club 2007

Membership Forms