Medical Release Horse/Rider I further agree to allow and be financially responsible for any necessary emergency medical treatment by any available physician at any available medical institution in the event of my injury or illness.
I have read and understand this liability release.
Date / / 12 Print Name Rider Signature /Parent Signature 1. 1. 2. 3. 4. 2. 3. 4. (Signature of Guardian if Rider is a Minor) Please continue on back side if more riders Street Address (Please print legibly as we use your address for mail outs) City St.
Zip Phone or cell E Mail: @ Please e mail me information regarding activities Charming Pony Parties. Pony Ride Carriage Rides Themed Parties Pony Camp Lessons and Camp only: In Case of Accident Notify: Phone: Any Known Allergies or Medical Conditions:
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