Clinic Registration Form
404 N Oak, Medicine Lodge, KS 67104
800-213-3736
[email protected].com

RIDER'S INFORMATON
Would you like to be added to our mailing list?
HORSE'S INFORMATON
Proof of a negative Coggins and current vaccinations must be provided before being allowed to participate in a clinic.
RELEASE, ASSUMPTION of RISK & INDEMNITY AGREEMENT MUST BE SIGNED AND MAILED PRIOR TO CLINIC!
Click here for printable Clinic Registration Form and Waiver.  Waiver MUST be signed and mailed, faxed, or scanned & e-mailed prior to clinic.
Clinic Location:
Clinic Dates:
Rider's Name:
Address:
Evening Phone:
City, ST, Zip:
Day Phone:
If YES, e-mail address:
Rider's Background &
Experience Level:
Horse's Name:
Horse's Age:
Horse's Sex:
Horse's Breed:
Horse's Background &
Training Experience:
What improvements or 
changes would you like
to see in your horse?