USPC Medical Release Instructions

      1)  DO NOT SIGN or date the forms yet.

 2)  Fill out one USPC Release Form with the information requested

(except for the signature lines at the top.)

• "Club No." is 080040

• "Club" is Covered Bridge Pony Club

•   "Region" is Midsouth

•  It is not necessary to include the second page or have a doctor’s signature unless 

•      you checked “Yes” in the “Existing Medical Questions” box at the bottom of Page 1.  

        3)  Make 6 copies; THEN sign and date the copies in BLUE ink.

                  Keep the unsigned original in case you need more.  

    *Note the parent signs twice on the top part of each form.

      - only members 18 or older need to sign this form.   

 4)  If you are joining for the first time, it is best to bring another copy along to

         your first meeting in case they have not received a copy from us yet.  

        Remember to take a copy to each barn where you attend.

The other copies will be used for mounted meetings, Quiz, Rally Camp (including when teaching at Camp for the Cs, Rally, upper level testings, etc.

            For problems or questions regarding this web contact Peggi Bindner

Last updated: 01/22/08.