OPTIMUM TIME CLINIC

Horse Power Farm Optimum Time Clinic

Horse Power Farm Optimum Time Clinic Entry Form

* Indicates required field

Riders Name *

First

Last

Junior or Senior *

Junior Senior

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Choose Correct Boxs *

PAYMENT ON CLINIC DAY Mounted Clinic Audit Clinic

Upload Coggins & Rabies *

Max file size: 20MB

2nd file upload if needed for coggins & rabies *

Max file size: 20MB

Horse Power Farm Liability Waiver
I hereby agree to release, indemnify and hold harmless Horse Power Farm, it's instructors, officers, directors, agents, and volunteers from and against any and all loss, liability or damage arising from or because of, or in connection with, participation in this competition or related activities. I also hereby agree to release, indemnify and hold harmless the show management, show committee and members, officers, directors, agents, and volunteers from and against any and all loss, liability or damage arising from or because of, or in connection with, participation in the competition or related activities.

E-Signature of rider over 18 or Guardian of rider under 18 *

Submit