Owner-Trainer Application

APPLICATION

In the event that a W-9 form is required for upload, please download the form from the following link: Form W-9 (Rev. October 2018) (irs.gov)

PLEASE CHECK OFF THE CATEGORY(IES) FOR WHICH YOU ARE APPLYING *

General Information

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Date of Birth *

Social Security Number *

Have you ever been convicted of a crime (except traffic violations)? *

Have you ever had a license denied, suspended or revoked? *

Have you ever been allowed by any Racing Commission or Association to withdraw your application for a license? *

Have you ever been suspended by the Stewards of any racing association, except at meetings sanctioned by the National Steeplechase Association? *

Owner Information

Pursuant to the provisions of NSA Rules of Racing,Chapter 6, II, application is hereby made for an Owner's License at race meetings under the jurisdiction of the National Steeplechase Association for the season of: *

Social Security or Tax ID Number : *

(Please note that this number will be used for income tax reporting purposes)

Name and Address of Your Bank: *

List the horses in training owned (wholly or in part) or leased by you: (If Leased, add "L" after name and list name of Lessor(s); if Partnership, add "P" and list name of Partner(s)) *

List Name of Your Trainer(s): *

Stable Name

Stable Name:

Name (Owner or, if for a partnership, Managing Partner):

Address:

Social Security or Tax ID Number:

(Please note that this number will be used for income tax reporting purposes for the stable name listed above.)

If registration is for a partnership, list names of all partners:

The Stable Name shall have no connection with any business nor shall it be used in any way for the advertisement of any product.

Colors

Describe Your Racing Colors

(Please note that design on front and back must be identical.)

Trainer Section

Pursuant to the provisions of NSA Rules of Racing,Chapter 6, III, application is hereby made for a Trainer's License at race meetings under the jurisdiction of the National Steeplechase Association for the season of: *

Horses in charge owned by:

Have you been licensed previously?

Applicants who have never been previously licensed by any turf authority must accompany this application with a letter stating previous experience:

Click or drag a file to this area to upload.

Letters of Endorsement

Click or drag a file to this area to upload.

Endorsements of new applicants must be made by two trainers currently licensed and in good standing with the NSA.

All trainers are required to complete 4 hours of Continuing Education to receive an NSA trainer’s license in 2023. CE courses, information, and resources can be found on the THA website at the following link: http://tharacing.com/continuing-education/ Certificates of completion should be attached below:

Click or drag a file to this area to upload.

Agreement & Signature

By the acceptance of any license issued pursuant to this application, I agree to abide by the Rules of Racing of the National Steeplechase Association and consent to any provisions which may be contained in any of them for the search, within the grounds of a racing association, of any premises which I may occupy and of my personal property and effects, and the seizure of any article, the having of which within the grounds may be forbidden and agree to accept the decision of the racing officials as final on any matter thereto or to a race or racing; and I certify that the foregoing statements are true and correct. By the acceptance of any license issued pursuant to this application, I consent to having all questions arising out of, or incident to, a race or racing, decided by the Stewards of the meeting, or the Directors of the National Steeplechase Association (NSA), as the case may be. As further consideration for the grant of a license to participate in any NSA sanctioned race meeting or event, the undersigned applicant (the "Licensee") expressly assumes any and all risk whether foreseeable or not, including all risks associated with steeplechase events such as risks associated with equine activities (including without limitation the propensity of an equine to behave in dangerous ways, which may result in injury to the participant, the inability to predict an equine's reaction to sound, movements, objects, persons, or animals, and hazards of surface or subsurface conditions), risks associated with sporting events, risks associated with spectator events where alcohol is served or consumed, with respect to participation or presence in any capacity in or at any NSA race meeting or event and agrees to the extent permitted by applicable law as follows: (A) Licensee shall be responsible and liable for any and all injury, including, but not limited to, physical injury, economic or pecuniary injury, mental or emotional injury, or property damage arising from, related to, based upon, or attributable to the acts or omissions of Licensee, his agents and employees. (B) Licensee shall indemnify the sponsoring committee, race committee, or race association; any charity or other beneficiary who may benefit from the races, the NSA; the owners, lessees, lessors, or licensees of any premises where a race meet may be held; all directors, officers, trustees, agents, employees, servants and licensees of any entity included in this paragraph (B), (hereinafter the "Indemnified Parties"), from any claim arising from, related to, based upon, or attributable to the acts or omissions of Licensee, his agents, and employees. (C) Licensee waives his rights against and forever discharges and releases the Indemnified Parties identified in paragraph (B) from liability for any claim which Licensee may now or hereinafter have for any injury including, but not limited to, physical injury, economic or pecuniary injury, mental or emotional injury, or property damage arising from, related to, based upon, or attributable to any act or omission of the Indemnified Parties identified in paragraph (B), riders, owners, trainers, any and all licensees of the NSA, spectators, and any and all third parties. (D) Licensee waives his rights against and forever discharges and releases all riders, owners, trainers, and any and all licensee or members of the NSA, from liability for any claim which Licensee may now or hereinafter have for any injury, including, but not limited to, physical injury, economic or pecuniary injury, mental or emotional injury, or property damage arising from, related to, based upon, or attributable to any act or omission of the Indemnified Parties identified in paragraph (B), riders, owners, trainers, any and all licensees or members of the NSA, spectators, and any and all third parties. All entries for races run under the jurisdiction of the National Steeplechase Association must be made on a signed entry form before a horse will be permitted to start. In those cases where entries are made by telephone, an owner or trainer may designate the NSA staff as his or her "authorized agent" for the purpose of entering and declaring horses. As a condition of said agency, the owner or trainer agrees to be bound by any and all acts performed by the agent on behalf of his principal in regard to the entrance and declaration of horses.

In consideration of the sum of $5 (which is included in the application fee) I have this day appointed the NSA Staff to act as AGENT for me to enter and declare horses for the year (selected below) at meetings sanctioned by the National Steeplechase Association.

NSA Horsemen's Directory:

Please do not include my name in the NSA Horsemen's Directory.
Include my name in the NSA Horsemen's Directory.

By my signature hereto, I confirm that I have read this application for a license in its entirety, I understand it, and I agree to be governed by it.

Date

Signature

Application Total

$ 0.00

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