Rider’s Registration
Including Release and Hold Harmless

Rider’s Name:___________________________________ Date:________________________________________
Address:_______________________________________City:____________________State:_________Zip:__________
Home Phone:___________________________________ Cell Phone:___________________________________
Work Phone :___________________________________ Email:________________________________________
Parent/Guardian (if Rider is under 18):_________________________________________Relation:__________________
Rider’s Date of Birth:_____________________________ Coupon/Promotion Code:________________________
How did you hear about us: Social Media/ Word of mouth/Advertisement__________________________________
Referral Name___________________________________ Other__________________________________________
Would you like to receive information on special package promotions and event, ( ) yes, ( ) no
Camp session(s)____________Are you interested in regular professional riding instruction? ( ) yes, ( ) no
Experience with horses:______________________________________________________________________________
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Health Concerns, Disabilities, Allergies__________________________________________________________________

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In the event of an emergency, please contact:_________________________________Relation____________________
Home Phone:_______________________Cell Phone:______________________Work Phone:_____________________