Musical Freestyle Rider Registration On-Line Form

Name:*
Address:*
E-mail:*
Phone:*
-
Horse's Name:*

Photocopy (like jpeg) of negative Coggins MUST be attached or entry will be rejected. Horse's name on Coggins must match name on entry. Click button to choose file:

Upload coggins File:
Date of current coggins:*
Horse's Age:
Horse's Breed:
Horse's color:
Horse's height:
Horse's Dressage Level:*
Horse Owner's name:*
Are you wanting :
Freestyle Level desired?:*
Style of music preferred:*
Ride time preference:

By entering my name in the box below, I acknowledge that my clinic fee is non refundable in the event that i cancel and no full replacement can be found for me.  I also acknowledge that I understand that this is not an instructional riding clinic but one intended to teach me how to select music and choreography appropriate for a musical freestyle.  I also understand that I will not leave the clinic with a fully designed freestyle.

Acknowledge signature Name:*
Liability Release

By entering the rider's name and the horse owner's name below, I understand that by paraticipating in the March 24 & 25, 2018 clinic, I do so at my own risk and risk to the above named horse.  I understand that Pine Lake Stable and facility staff, GLASS-ED, or anyone acting on their behlaf are not responsible for accidents, damage or injury or illness to the horses, specatatos, or any other person in connection with this clinic.  By signing this for, I agree to abide by the clinic rules and facility rules and will fulfill all financial commitments related to this clinic.  Regardless of any agreements between the rider and the horse;s owner, the rider, as a clinic participant, is untimately responsible for paying fhe $295 clinic fee and applicable stabling fee to GLASS-ED as well as any damage that the horse or myself may casue to the stabling or to the facility hosting the clinic

ASTM/SEI Certified helmets must be worn by all riders


Riders Liability release signature :*
Dated:*
Horse Owner's liability Release signature :*
Date:*

A slight surcharge is added to cover Paypal's fee

Rider Registration:*
Stabling
Horse Arrival Day & time (not before Fri 4PM):*
Stabling Fees:
Total being paid through Paypal:
Security Word Verification:
>You will receive an email confirmation from Glass Ed that your registration has been received.
>Paypal will send a separate email indicating that your payment has gone through.
If you do not receive both confirmations; then contact Joanne at JCoy52@gmail.com for clarification

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