Clinic Form
Thank you for your interest in being a part of our clinics! This particular clinic is GROUNDWORK ONLY! Please answer all required questions and please remember to be as open and honest as possible, so you get the most out of your experience! We can't wait to meet you!
Tell Us About YOU!
What is your Name?
*
First Name
Last Name
What is your Email?
*
example@example.com
Where do you live?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What's a good number to reach you at?
*
Please enter a valid phone number.
Are you 18 or older?
*
Yes
No
If not, a parent or guardian must be present with you, unless you have obtained prior written permission. Do you understand?
Yes
No
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Emergency Contact
We hope that we don't need it, but we ask that even if you are auditing, you provide an emergency contact.
Emergency Contact's Name:
*
First Name
Last Name
Relationship to You:
*
Emergency Contact Phone Number:
*
Please enter a valid phone number.
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I would like to:
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Audit
Participate
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August 23rd and 24th, 2025 in Lone Jack, Missouri
Cost to audit is $20 for the weekend. To reserve your spot, you must pay in full.
Do you understand that your spot is not reserved until you pay in full?
*
Yes
No
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August 23rd and August 24th, Lone Jack, Missouri
Cost is $250 for the weekend, this does NOT include stalls! Please contact Kelly to reserve your stall: 816-547-9508.
Horse's Name:
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Breed (if known):
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Gender (Please Note: We do not accept studs at this clinic):
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Mare
Gelding
Are there any health concerns for the Horse or the Handler?
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Yes
No
If yes, please explain:
*
Please list any previous training your horse has received (including clinics):
*
Primary Riding Discipline:
*
What are your goals for your horse?
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What are your goals for yourself?
*
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Equine Health
Please Note: Most facilities require a current vaccine record as well as Coggins
Do you have a current Coggins and Vaccine Record on your horse?
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Yes
No
I will by the time of the clinic
Please upload Coggins here if you currently have it. You can also email it to connectedcoltshorsemanship@gmail.com
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August 23rd and 24th, 2025 in Lone Jack, Missouri
Cost to attend the clinic is $250 for both days. This does NOT include accommodations for your horse! I require a 50% non-refundable* deposit of $125 to secure your spot. *IF you find someone to fill your spot, you can be refunded.
Do you understand that your spot is not reserved until you pay a 50% non-refundable deposit
*
Yes
No
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Payment Options
Deposit payment link will be sent to the email on file within 24 hours so you can pay with either a credit or debit card. The remaining amount must be paid 7 days prior to the clinic. We will send a separate link for the remainder.
Your spot is not secured until the deposit is received.
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