FreeHorse Arts Registration Form

FreeHorse Arts

Registration Form
Participant Name*

First Name Nickname or preferred nameLast Name
Birth Date

MonthDayYear
Participant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant Email*
example@example.com
Participant Phone Number *
Parent or Guardian Email *
example@example.com
Emergency Contact *
First and last name
Emergency Contact Number*
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What Program are you registering for?*

FreeHorse Arts LiveFreeHorse Arts Interconnected
IMPORTANT:

The following questions are designed to support the needs of the participants. FreeHorse Arts is committed to non-discriminatory inclusion. Response to the following is optional.
Do you have any specific conditions, to include medical, or needs that the teaching staff should be aware of in order to facilitate an ideal learning environment?
Are there any accommodations that you will need to be successful in the program?
Do you normally receive the assistance of a one-on-one aide or assistant? If so, please describe in what capacity and in which settings and if this person will be available to assist you during the online course.
- I acknowledge that FreeHorse Arts takes all precautions with its participants and agree to hold harmless and indemnify FreeHorse Arts or any of its staff, partners and guest artists, officers and agents from all claims, liabilities, damages or injuries.
- I agree that I am responsible for all medical costs, bills and expenses resulting in providing medical care to myself/my participant.
- I agree to review and complete any and all additional questionnaires, waivers and agreements that are applicable to specific field trips, work with horses, special performances, travel within or outside of my local community as new opportunities arise.
- I agree to have images of myself and my class featured on the FreeHorse Arts website and in any/all FreeHorse Arts promotional materials.
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