Horse Information Form

Race For A Cure - May 22-24, 2026 - HORSE SHOW INFO FORM

You must sign at the end of this form. You are more than welcome to review the terms and conditions of the Treatment Agreement form attached. Payment is accepted at the time of service in cash, check, Paypal, or Venmo. **There is a 4% processing fee applied to PayPal or Venmo payment!**
Owner Name

First NameLast Name
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Horse Registered Name
Horse Barn Name
Horse Age
Select all classes your horse will be running Friday
Select all classes your horse will be running Saturday
When would you like your treatment(s) /test done?
I will be offering treatments & test for Friday and Saturday. I will be running the poles so I will not be available for LARC testing during those classes. PLEASE LIST what day you FOR SURE want a treatment/test. (EX: Friday for sure, Saturday if you have time.) THANK YOU!!
Do you give CREC permission to post pictures/videos of said horse on social media?
Horse Show Service Pricing:
- LARC Test - $100/test
- Acuscope/Myopulse - $85/treatment
- MagnaWave - $50/30 minute session
- Bemer - $25 session
- FlexiNebulizer - $25/session
Are you wanting to only LARC test this horse or both therapy & LARC test?
Select ALL therapies you want done on this horse.
General problem areas or previous injuries CREC needs to be aware of
Has said horse received any joint injections in the past 10-14 days prior to arrival at CREC? *IF YES, please disclose injection sites in the OTHER option.*

Other
Is said horse known to bite, kick, rear, strike, etc at people?
Select the following therapies that said horse receives on a REGULAR basis.

Other
I understand that if said horse is currently on any anti-inflammatory medication or use of any type of alternate therapy 48-72 hours prior to the Acuscope/Myopulse treatment, the digital readings displayed by the Acuscope could be altered. These readings could not be accurate, but said horse still would receive benefits from treatment.
I understand that if my horse runs on Lasix, the treatment must be done one hour prior to administering the medication to ensure the horse has adequate time to hydrate before pulling their water after the Lasix is given.
PRE treatment recommendations- Your horse needs to be fully dry and free from any therapy devices or products, such as Back on track sheets and boots, magnetic therapy sheets or boots, etc. It is also recommended to withhold the use of alternative therapy modalities such as the MagnaWave or Bemer. Use of said therapy products could significantly impact the benefits and healing properties of the treatment. Mixing the therapies will not hurt the horse but, neither therapy used will be able to work as effectively as it normally would rather than using one or the other.
POST treatment recommendations- Horse can be sprayed off after treatment. A single treatment will stay in their system for 12-48 hours. It is recommended to avoid use of alternative therapy products and devices post treatment to ensure your horse receives the highest benefits possible from the Acuscope/Myopulse treatment. Use of said therapy products could significantly impact the benefits and healing properties of the treatment. Neither therapy used will be able to work as effectively as it normally would rather than using one or the other.
Read the Treatment Agreement before signing.

By signing below, I agree to the terms & conditions in the Treatment Agreement, and the information I have provided on this form is accurate to the best of my knowledge. I understand that Cooper Ridge Equine Center and its staff are not liable for any incidents, injuries, or harm done to said horse due to inaccurate information.
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Race For A Cure - May 22-24, 2026 - HORSE SHOW INFO FORM