2015 4-H Lesson Registration

2021 Mackinac 4-H Horse Club Riding Lesson Registration
Today's Date

MonthDayYear
Youth's Full Name

First NameLast Name
Parent(s) Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
E-mail
Youth's Birth Date

MonthDayYear
Emergency Contact Name:
Emergency Phone
This Registration FormMackinac County MSU 4-H Enrollment(Free)- onlineGiddy Up & Go Club - 5 to 8 year oldsGalloping Gliders - 9 to 19 year olds
Under the Michigan Equine Activity Act, an equine professional is not liable for an injury to or the death of a participant in an equine activity resulting from an inherent risk of the equine activity.
Parent/Guardian Electronic Signature*

First NameLast Name
Should be Empty:

2021 Mackinac 4-H Horse Club Riding Lesson Registration