Horsemanship Registration + Release Horsemanship 101 Registration The 6-week session fee is $270. Main Stay's accounting manager will send you an invoice via email from [email protected]. Please ensure your email address is accurate. Payment is required prior to the start of the session. First name * Last name * Date of birth * Age * Preferred pronouns Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email * Phone * In case of emergency contact * Mobility (any issues or concerns) * Do you have a history of any of the following: Asthma * No YesYes Allergies (e.g., food, environmental, medication) * No YesYes Allergy to bee stings * No YesYes Allergy to dust * No YesYes Allergy to animals * No YesYes Other * No YesYes Please describe your previous horsemanship experience including level of experience and how long ago * What would you like to accomplish? Is there any other information that will enhance your time at the farm? * Participant Acknowledgement * I understand that this horsemanship class is designed for individuals who are able to attend and participate independently. By checking this box, I confirm that I am enrolling in this class to enhance my knowledge of horses, can follow group instructions without one-on-one support and do not require behavioral or physical assistance to participate. LIABILITY RELEASE Consent Signature * signature keyboard Clear Client (18 years or older), Parent or Guardian Date Signed * PHOTO RELEASE Participant's Name * I, First and last name Give Consent * DO DO NOT hereby grant irrevocable and unlimited consent to the use and reproduction by Main Stay Therapeutic Farm, its assigns, licensees and legal representatives, of any and all photographs and any other audio/visual materials taken of me, my child or my ward, in all forms and media (including but not limited to printed media, digital media, web sites, video and audio productions). The materials may be reproduced in all forms including composite, altered or derivative works, for promotional material, educational activities, and exhibitions or for any other lawful use for the benefit of the program. I hereby waive the right to inspect and approve the finished version(s) including any copy that may accompany the materials. I hereby release Main Stay and its employees, volunteers, assigns, licensees and legal representatives from all claims and liability relating to said materials. I sign this release as a person with, or the parent or guardian of a person with special needs, understanding that use of these materials will make them available to the general public. I have read and understand the above release, am over 18 and have the capacity to sign this release of my own free will. (18 years and older) Participant Signature * signature keyboard Clear Date Signed * Captcha Submit If you are human, leave this field blank. Rider Registration + ReleaseRider Financial Assistance ApplicationEAAL Registration + ReleaseHorsemanship Registration + ReleaseSaddle Up Registration + ReleaseSession PaymentFacility Rental Agreement
