Let's get to know you!

Clinic Registration Step 1 of 3

Please complete the form below to tell us more about you and your horse:

Which Fresh Start Clinic Are you Signing up For? *

About You

Full Name *

Address *

City *

State *

Postal code *

Email *

Phone *

Lunch will be ordered from Panera Bread. Please review the menu here. (if you are signing up for more than one clinic, please just enter your order for the first clinic).

Please Submit your lunch order for all 3 days: *

Day 1
Day 2
Day 3

For Minors Under 18 Years of Age

Minors under 18 MUST wear a helmet.

Name of Parent(s) or Guardian

Participant Birth Date

About Your Horse

Your Horse's Name *

Your Horse's Breed *

Age *

Sex *

Mare

Gelding

Stallion

Owner Name and Phone Number *

Vet Name and Phone Number *

Allergy/Medical Conditions *

If possible, please submit your horse's negative coggins and vaccine record:

Emergency Contacts

Emergency Contact Name and Relationship #1 *

Emergency Contact Cell #1 *

Emergency Contact Name and Relationship #2

Emergency Contact Cell #2

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Privacy Policy | Terms of Service

Powered by Horse Business Manager