FOR OFFICE USE ONLY

DATE: ___________

TIME: ____________

Build a Pony Workshop

Registration Form
Please print the following information regarding you and your child:
Childs Name:_________________________ Age:_______ Birthdate:___/___/___ Circle: Male Female
Parents/Guardians Name Participating:______________________________________
Address:__________________________________ Email Address:_________________________________
City:______________________________ State:_______ Zip:_________________
Home Phone:_(______)_____________________ Cell Phone: _(______)_____________________
BALANCE DUE: $45.00

Amount Enclosed: ________________

WARNING
UNDER INDIANA LAW, AN EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJUSRY TO, OR
THE DEATH OF, A PARTCIPANT IN EQUINE ACTIVITIES RESULTING FRONM THE INHERENT
RISKS OF EQUINE ACTIVITIES.
Date:____________________________ Signature of parent/guardian:______________________________
4613 E. 109th Ave. Crown Point IN, 46307 * (219)663-5968 * Email: horses4s@horses4seasonsstable.com