{"id":1331,"date":"2025-05-22T17:01:03","date_gmt":"2025-05-22T22:01:03","guid":{"rendered":"https:\/\/blazintrailschurch.com\/?page_id=1331"},"modified":"2025-05-22T17:01:06","modified_gmt":"2025-05-22T22:01:06","slug":"brookes-roundup-2025-registration-and-release-form","status":"publish","type":"page","link":"https:\/\/blazintrailschurch.com\/index.php\/brookes-roundup-2025-registration-and-release-form\/","title":{"rendered":"Brooke&#8217;s Roundup 2025 Registration and Release Form"},"content":{"rendered":"<p><a href=\"https:\/\/docs.google.com\/forms\/d\/e\/1FAIpQLSe68j7MwztV63NXnYaLkG_2keq8KFXvd7LJcFWAOrLHIFul-w\/viewform\">https:\/\/docs.google.com\/forms\/d\/e\/1FAIpQLSe68j7MwztV63NXnYaLkG_2keq8KFXvd7LJcFWAOrLHIFul-w\/viewform<style id=\"wpforms-css-vars-1039\">\n\t\t\t\t#wpforms-1039 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-1039\"><form id=\"wpforms-form-1039\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1039\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1331\" data-token=\"6f8560999bfe76f93eba535a0a3007a5\" data-token-time=\"1776663593\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Brooke&#039;s Round Up Registration Form<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1039-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Participant&#039;s Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1039-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-1039-field_0-error\" required><label for=\"wpforms-1039-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1039-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-1039-field_0-last-error\" required><label for=\"wpforms-1039-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1039-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_16\">Participants date of birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_16\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-alias=\"datetime\" data-inputmask-inputformat=\" mm\/dd\/yyyy\" data-inputmask-inputmode=\"numeric\" name=\"wpforms[fields][16]\" placeholder=\"MM\/DD\/YYYY\" aria-errormessage=\"wpforms-1039-field_16-error\" required><\/div><div id=\"wpforms-1039-field_12-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Parent\/Guardian Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1039-field_12\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][12][first]\" aria-errormessage=\"wpforms-1039-field_12-error\" required><label for=\"wpforms-1039-field_12\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1039-field_12-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][12][last]\" aria-errormessage=\"wpforms-1039-field_12-last-error\" required><label for=\"wpforms-1039-field_12-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1039-field_28-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_28\">Parent\/Guardian Relation to Participant <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_28\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-1039-field_28-error\" aria-describedby=\"wpforms-1039-field_28-description\" required><div id=\"wpforms-1039-field_28-description\" class=\"wpforms-field-description\">Parent\/Caretaker\/Group Home, etc<\/div><\/div><div id=\"wpforms-1039-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_4\">Mailing Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-1039-field_4-error\" aria-describedby=\"wpforms-1039-field_4-description\" required><div id=\"wpforms-1039-field_4-description\" class=\"wpforms-field-description\">Please list the address where the participant resides.<\/div><\/div><div id=\"wpforms-1039-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_20\">Telephone Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_20\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"(999)-999-9999\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-1039-field_20-error\" aria-describedby=\"wpforms-1039-field_20-description\" required><div id=\"wpforms-1039-field_20-description\" class=\"wpforms-field-description\">Telephone Number<\/div><\/div><div id=\"wpforms-1039-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_22\">Email Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-1039-field_22-error\" required><\/div><div id=\"wpforms-1039-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_27\">Emergency Contact Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_27\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-1039-field_27-error\" required><\/div><div id=\"wpforms-1039-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_21\">Emergency Contact Phone Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_21\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"(999)-999-9999\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-1039-field_21-error\" aria-describedby=\"wpforms-1039-field_21-description\" required><div id=\"wpforms-1039-field_21-description\" class=\"wpforms-field-description\">We require an Emergency contact in addition to the number where the participant resides.<\/div><\/div><div id=\"wpforms-1039-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_25\">Number of Guests Attending with Participant  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" aria-errormessage=\"wpforms-1039-field_25-error\" aria-describedby=\"wpforms-1039-field_25-description\" required><div id=\"wpforms-1039-field_25-description\" class=\"wpforms-field-description\">Parents, siblings, family, etc.<\/div><\/div><div id=\"wpforms-1039-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_24\">Please indicate the participant&#039;s special need(s)\/disability <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_24\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][24]\" aria-errormessage=\"wpforms-1039-field_24-error\" required><\/div><div id=\"wpforms-1039-field_7-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Does the participant require the use of ambulatory aids?<\/legend><ul id=\"wpforms-1039-field_7\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1039-field_7_1\" name=\"wpforms[fields][7][]\" value=\"Yes\" aria-errormessage=\"wpforms-1039-field_7_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1039-field_7_1\">Yes<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-1039-field_7_8\" name=\"wpforms[fields][7][]\" value=\"No\" aria-errormessage=\"wpforms-1039-field_7_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1039-field_7_8\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1039-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_23\">If you answered &quot;YES&quot; to the question above please indicate what type of ambulatory aids. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-1039-field_23-error\" aria-describedby=\"wpforms-1039-field_23-description\" required><div id=\"wpforms-1039-field_23-description\" class=\"wpforms-field-description\">If you answered No, please put N\/A<\/div><\/div><div id=\"wpforms-1039-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_17\">Parent\/Guardian Electronic Signature <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-1039-field_17-error\" aria-describedby=\"wpforms-1039-field_17-description\" required><div id=\"wpforms-1039-field_17-description\" class=\"wpforms-field-description\">By typing your name here, you agree that this electronic signature is made by the parent\/guardian and that it is as binding as a written signature.<\/div><\/div><div id=\"wpforms-1039-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-1039-field_26\">Electronic Signature Date <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1039-field_26\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-alias=\"datetime\" data-inputmask-inputformat=\" mm\/dd\/yyyy\" data-inputmask-inputmode=\"numeric\" name=\"wpforms[fields][26]\" placeholder=\"MM\/DD\/YYYY\" aria-errormessage=\"wpforms-1039-field_26-error\" required><\/div><div id=\"wpforms-1039-field_15-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">Photo Release <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1039-field_15\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1039-field_15_1\" name=\"wpforms[fields][15][]\" value=\"I agree and give my permission\" aria-errormessage=\"wpforms-1039-field_15_1-error\" aria-describedby=\"wpforms-1039-field_15-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1039-field_15_1\">I agree and give my permission<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1039-field_15_2\" name=\"wpforms[fields][15][]\" value=\"I do not agree\" aria-errormessage=\"wpforms-1039-field_15_2-error\" aria-describedby=\"wpforms-1039-field_15-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1039-field_15_2\">I do not agree<\/label><\/li><\/ul><div id=\"wpforms-1039-field_15-description\" class=\"wpforms-field-description wpforms-disclaimer-description\">I give consent to and authorize the use and reproduction by Blazin' Trails Cowboy church and any and all photographs and any other audio\/visual taken of the participant for promotional material, educational activities, exhibitions or for any other use for the benefit of the program.<\/div><\/fieldset><\/div><div id=\"wpforms-1039-field_29-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"29\"><fieldset><legend class=\"wpforms-field-label\">Liability Release <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1039-field_29\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1039-field_29_1\" name=\"wpforms[fields][29][]\" value=\"I HAVE READ THE BELOW RELEASE IN FULL AND AGREE TO THE TERMS\" aria-errormessage=\"wpforms-1039-field_29_1-error\" aria-describedby=\"wpforms-1039-field_29-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1039-field_29_1\">I HAVE READ THE BELOW RELEASE IN FULL AND AGREE TO THE TERMS<\/label><\/li><\/ul><div id=\"wpforms-1039-field_29-description\" class=\"wpforms-field-description wpforms-disclaimer-description\">Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina General Statutes.\"<br \/>\n<br \/>\nI acknowledge that there are inherent dangers and risks in horseback riding and in being around or working with horses. I realize that I\/my child could sustain injuries including life threatening injuries while engaging in horseback riding or while being around or working with horses I am willing to accept these risks.<br \/>\n<br \/>\nI agree to indemnify Roy Blanton, Blazin\u2019 Trails Cowboy Church, Jumpin' Jacks Party Rentals, from any and all claims, demands, suits, or liability which may be brought against them by others as a result of injuries sustained by myself\/child while riding at the facilities and while riding or working with their horses in any way.<br \/>\n<br \/>\nI acknowledge it is the rider\u2019s responsibility to wear protective headgear while mounted. It has been recommended to me that the protective headgear meet the A.S.T.M. (American Society for Testing<br \/>\nMaterials) standard and display the SEI (Safety Equipment Institute) seal.<br \/>\n<br \/>\nRoy Blanton, Blazin\u2019 Trails Cowboy Church, Jumpin' Jacks Party Rentals, its employees and\/or representatives make no representation or warranty expressed or implied about any protective headgear and cautions riders that serious injury and death may result despite wearing such headgear as all equestrian sports involve inherent risk and that no protective helmet can protect against all foreseeable injury.<br \/>\n<br \/>\nI acknowledge that it is the rider\u2019s responsibility to wear appropriate footwear while on the premises of Blazin\u2019 Trails Cowboy Church. I agree to wear this footwear whether mounted or on the ground. This<br \/>\nfootwear will include shoes\/boots and socks. Shoes or boots will have a flat tread sole, a 1\u201d heel, and a fully enclosed upper. Boots or shoes designed for the purpose of equestrian activity are preferred but not required.<br \/>\n<br \/>\nI acknowledge that it is the rider\u2019s responsibility to wear appropriate clothing which will include but not be limited to full length pants and minimal jewelry. I understand that Blazin' Trails Cowboy Church accepts no liability for injury or damage to clothing\/jewelry or injury caused by clothing\/injury and reserves the right to request that I change clothing\/jewelry that is deemed unsafe.<br \/>\n<br \/>\nI ACKNOWLEDGE that I have read the above release in full and release Roy Blanton, Blazin\u2019 Trails Cowboy Church, Jumpin' Jacks Party Rentals, of all liability relating to the activities that I have chosen to participate in.<\/div><\/fieldset><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1039\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/blazintrailschurch.com\/index.php\/wp-json\/wp\/v2\/pages\/1331\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1039\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/blazintrailschurch.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/a><\/p>\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>https:\/\/docs.google.com\/forms\/d\/e\/1FAIpQLSe68j7MwztV63NXnYaLkG_2keq8KFXvd7LJcFWAOrLHIFul-w\/viewform<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"give_campaign_id":0,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-1331","page","type-page","status-publish","hentry"],"aioseo_notices":[],"campaignId":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/blazintrailschurch.com\/index.php\/wp-json\/wp\/v2\/pages\/1331","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blazintrailschurch.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/blazintrailschurch.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/blazintrailschurch.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blazintrailschurch.com\/index.php\/wp-json\/wp\/v2\/comments?post=1331"}],"version-history":[{"count":2,"href":"https:\/\/blazintrailschurch.com\/index.php\/wp-json\/wp\/v2\/pages\/1331\/revisions"}],"predecessor-version":[{"id":1334,"href":"https:\/\/blazintrailschurch.com\/index.php\/wp-json\/wp\/v2\/pages\/1331\/revisions\/1334"}],"wp:attachment":[{"href":"https:\/\/blazintrailschurch.com\/index.php\/wp-json\/wp\/v2\/media?parent=1331"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}