HCE 2024 Pole Dancing Clinic Registration

Pole Dancing Clinic Registration Form

Name

Address

Phone

Email

example@example.com

Riding Experience

Any known medical conditions

Emergency Contact

Select Clinic

September 7 - 11am to 1pm beginner (walk/trot)2pm to 4pm Beginner Advance/Intermediate (walk/trot/canter) 2 groups per level with 1 hour session per group Sign up by 9/1October 13 - 11am to 1pm beginner (walk/trot)2pm to 4pm Beginner Advance/Intermediate (walk/trot/canter) 2 groups per level with 1 hour session per group Sign up by 10/1

Participate in both levels for an additional $25 (if space is available)

Select One

Rent a TPH owned horse for $10Bringing own horse (Must provide current coggins)

Bringing Own Horse please provide coggins access # , state drawn date drawn .

Select class or classes based on riding experience. Open to all ladies 18 and over.

Registration form and $55 NONREFUNDABLE class fee due by day before class. Spot is not held until full fee is paid. Spots are limited so get signed up ASAP!

Check payable to:Toms Performance Electronic Payments Horses, LLC Venmo: Danielle-Kernen (0377) 2965 Hat Creek Rd PayPal friends and family: Danielletoms80@gmail.com Brookneal, VA 24528

I, the camper or guardian of the minor (under 18), enter the above horse at my own risk subject to all rules and regulations of the show and Hat Creek Equestrian. I agree if any injury or death occurs to the animal exhibited, myself or minor exhibitor, spectators, or damage to any personal property on the grounds, that I hereby waive and release any claim to liability whatsoever from Hat Creek Equestrian, all committees, property owners, employees, members, and volunteers whether the injury, death, or damage be caused by gross negligence or simple negligence of Hat Creek Equestrian.

Exhibitor Signature or guardian if under 18

Date