Participant Registration Form

Participant Registration Form

M3 Equine, LLC
Information of Participant
Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
FemaleMalePrefer not to answer
Please indicate a few options for Availability. *
**We will try our best to accommodate but there is no guarantee.**
Information of Parent

**If participant is a minor**
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Place of Work
Emergency Contact 1
In the event of an emergency, please contact:
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Place of Work*
Medical Information
Doctor's Name*

First NameLast Name
Doctor's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Preferred hospital*
Insurance/health coverage*
Per our insurance you must have current health insurance coverage in order to participate in our program.
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns.
**If you or your minor have any medical issues that could impact the ability to ride and care for the horses you must document it and bring a release to ride from your Doctor. Thank you for your understanding.**
Should be Empty:

Information of Participant