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REGISTRATION FORM
CENTERED RIDING CLINIC Mar 19 - 21
PLEASE RETURN BY Mar 1 TO:
Lynn Larson, 100 CR 166, Georgetown TX 78626
Deposit or Full Payment must be included to reserve a clinic space.
Questions? Please call Lynn 512.869.7903/lynn@satori.com

Name____________________________________ Phone ____________ 
Address__________________________________ City_________________ State______ Zip______ 
Adult______ Junior______ (age_______) Email: __________________________________________

Clinic Rider Registration: $250 for clinic; $100 deposit
[  ] I will bring my own horse. ( I ____ need stabling for ____ days.) Stall fee: ($  5 )/ day
[  ] I need a school horse (if available). Rider's height ______ weight_____ horse fee: ($   25 )/ ride
Clinic Auditor Registration: $100 for clinic; $50 deposit

Any problems we should be aware of (medical restrictions, confidence problems, on medication)?
[  ] No [  ] Yes (please describe:)

Riding Level: ______________        Preferred Seat / Style of Riding:____________________________

[  ] Basic (or lacking confidence)  [  ] Advanced  [  ] Jumping (if offered)  
[  ] Novice (walk/trot, some canter)  [  ] Instructor  What size fences are you  
[  ] Intermediate    [  ] Riding green horse  comfortable jumping?  

Please provide some information about your riding experience and major riding interest:

 

Please provide some information about the horse you will be bringing to the clinic (age, training level, etc:)

 

Have you had any experience in Centered Riding (lessons from CR Instructor, Clinics, etc.)?

 

Important: What would you like to learn from this clinic?

 

I understand that there is an inherent risk of injury in riding and handling horses, and I agree to accept that risk by enrolling myself or my child to participate in this clinic. I agree to hold harmless Lynn Larson, Taryn Stafford, and all family and heirs; I assume responsibility for any accident, injury, or damages to persons or property caused by myself or my horse at this clinic. (or insert your own liability release)

Signature: Date:
                                                                                                                                                      
If Participant is under 18, parent or guardian must sign:
Parents or Guardians Signature:  Date:
                                                                                                                                                     

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