Whoa-Ga!      
 
  STEP 1: Registration  

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ONLINE REGISTRATION FORM and PAYMENT BY CREDIT CARD
 
Group leader's name:
Participant's name:
Email:
Mailing address line 1:
Mailing address line 2:
City:
State:
Zip:
Home phone:
Work phone:
Date of birth:
Riding ability: Beginner   Intermediate  Advanced
Parent/guardian name:
Emergency contact person:
Emergency phone
   
PHOTO RELEASE I hereby consent to and authorize
  I do not consent to, nor do I authorize
  the use and reproduction of any and all photographs and other audiovisual materials taken of me/participant by Cathy Reynolds for promotional printed material, educational activities, exhibitions, or for any other use for the benefit of the program.
   
LIABILITY RELEASE (PLEASE READ CAREFULLY -- Required):
  Name:   
  Would like to participate in the Whoa-Ga!™Yoga and Horseback Program. I acknowledge the risks and potential for risks of horseback riding and related equine activities, including grievous bodily harm. However, I feel that the possible benefits to myself/my child/my ward are greater than the risk assumed. Thereby, intending to be legally bound for myself, my heirs and assigns, executors, and administrators, waive and release forever all claims for damages against Cathy Reynolds or Whoa-ga, LC for any and all injuries and/or losses I/my child/my ward may sustain while participating in the Program from whatever cause including but not limited to the negligence of these released parties.

The undersigned acknowledges that he/she has read this Registration and Release Form in its entirety; that he/she understands the terms of this release and by clicking the Submit button below has agreed to this release voluntarily and with full knowledge of the effects thereof.

   
Optional instruction:
diet, allergies etc...
 



  
 

Whoa-Ga!™ is a registered trademark of Cathy Reynolds. All materials ©2005-2008 Cathy Reynolds, Stockbridge, Vermont.All Rights Reserved.
Use, duplication, or disclosure of Whoa-Ga!™ or any of the materials associated with Whoa-Ga!™ without authorization, is strictly prohibited.

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