Brambletye Farm

Clinic Registration Form

One form per horse/rider combination

MAIL COMPLETED FORMS TO: Anthea Kin, 5201 E. 211 Street South, Mounds, OK 74047

 

RIDER INFORMATION (please print)

Rider Name                                                                                                 Address                                                                                                        

City, State, Zip                                                        Phone                                                           E-mail                                                                      

 

HORSE INFORMATION

Horse’s Name                                                           Breed                                                        Age            Height                    Color                      

Sex                            Owner’s Name                                                                                                                                                                               

 

HISTORY

At what level are you currently working?  Schooling:                                                                       Showing:                                               

How long have you and this horse been working at this level?                                                                                                                         

Write a brief description of your abilities.                                                                                                                                                               

Have you ridden or competed at a level above what you’re currently working?                                                                                          

If yes, what is the highest level you have worked?                                                                                                                                               

At what level is your horse currently trained?                                                                                                                                                        

What are your short and long term goals for this horse?                                                                                                                                     

Deposit Required:  $150 non-refundable per horse.

LIABILITY RELEASE AND ACKNOWLEDGEMENT OF FINANCIAL RESPONSIBILITY

I understand that by participating in the clinic, I do so at my own risk and risk to the above named horse.  I understand that Brambletye Farm and its staff, volunteers, clinician, or any other person acting on their behalf are not responsible for accidents, damage, injury or illness to the horses, riders, auditors, or any other person in connections with this clinic.  By signing this form, I agree to fulfill all financial commitments related to this clinic.  Regardless of any agreements between the rider and the horse’s owner, the rider, as the clinic participant, is ultimately responsible for paying the $150/day clinic fee and the stabling and any related fees to Anthea Kin.

 

                                                                                                                                                                                                           

Rider’s Signature                                                                                                        Date

                                                                                                                                                                                                           

Signature of Parent/Guardian (if rider is under 18)                                              Date

                                                                                                                                                                                                           

Horse Owner’s Signature                                                                                         Date

CLINIC FEES

· Participation fee:  $150/ride students only

· Auditor fee:  $10/day—non-students, by invitation only.

· Stall:  $25/night—Owners are responsible for providing and feeding feed and hay and cleaning the stall.

· Paddock:  $15/night—Owners are responsible for providing and feeding feed and hay.

PREFERRED RIDE TIME  (Please circle AM or PM of days you wish to ride.)

SPECIAL RIDE TIME REQUESTS (i.e. last ride of day)