Equine Clinic Registration & Liability Form

Equine Clinic Registration & Liability Form

Complete the form with you and your horse's details, upload records, and follow payment instructions to register for the clinic.
Clinic Details
Clinician Name
Clinic Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Clinic Location
Rider Information
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Horse Information
Horse Name
Breed
Age
Sex
Color and Markings
Registration Number
Upload Coggins Test (PDF or Photo) OUT OF STATE HORSES MUST HAVE

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Upload Horse Photo

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Emergency Contact
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Rider
Riding Experience and Discipline
Years of Riding Experience
Primary Discipline
Clinic Goals (What do you hope to achieve at this clinic?)
Stall/Boarding Requests
Do you require a stall or overnight boarding?
Special Requests or Notes for Boarding
Liability Waiver and Assumption of Risk
Liability Waiver: I acknowledge the risks inherent to equine activities and agree to hold harmless Price Equine, KH Spa & Wellness, their owners, staff, and affiliates from any liability for injury, loss, or damage. I confirm I have read and understand this waiver.
Emergency Veterinary Treatment Authorization
Emergency Veterinary Authorization: In the event of an emergency, I authorize Price Equine and KH Spa & Wellness to seek veterinary treatment for my horse if I cannot be reached.
Optional Photo/Media Release
I grant permission for photos/videos taken during the clinic to be used for promotional purposes.
Digital Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

My Products

Clinic Deposit

Non-refundable deposit to secure your spot.

$150.00

Clinic Participation Fee

Full participation fee for the clinic event.

$250.00

Overnight Stall Fee

Fee for overnight stall/boarding (per night).

$15.00 Quantity

Two day clinic $400

$400.00 Quantity

Total

Credit Card

Select Clinician
I understand my clinic spot is not held until payment is received.
Should be Empty:

Equine Clinic Registration & Liability Form

Clinic Details

Rider Information

Horse Information

Emergency Contact

Riding Experience and Discipline

Stall/Boarding Requests

Liability Waiver and Assumption of Risk

Emergency Veterinary Treatment Authorization

Optional Photo/Media Release

My Products

Credit Card