Camper Contact Information
Camper 1 Info
Camper 1 Name (required)
Camper 1 Age (required)
Camper 1 Birthdate (required)
Camper 1 Riding Experience (required)
Less than 10 hours10 to 20 hours20 hours or more
Camper 1 Allergies, Medical Needs, Special Accommodations (required)
(This information MUST accompany this registration form.)
Emergency Contact Information
Contact 1 Name: (required)
Relationship: (required)
Day Phone: (required)
Contact 2 Name: (required)
Relationship: (required)
Day Phone: (required)
Insurance Information
Policy Holder Name:
Policy Holder Phone:
Insurance Carrier Name:
Insurance Policy ID#:
I, , agree to pay ANY medical costs and give permission for my child to be treated if I cannot be reached.
[acceptance* acceptance-1] Check this box to accept the above statement. (required) [/acceptance]
ACKNOWLEDGEMENT OF MISSOURI STATUTES
RIDING INSTRUCTION AGREEMENT AND LIABILITY RELEASE
By this agreement, made and entered this day of by and between , who resides at , hereinafter referred to as "I”, and KRAUS FARMS, INC. located at 333 Hillsboro Rd., High Ridge, MO 63049, hereinafter referred to as "THIS STABLE".
IT IS HEREBY AGREED TO AS FOLLOWS:
By signing below you:
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Consent to receiving electronic communications from us.
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Agree that electronic communications have the same effect as if provided to you on paper.
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Agree that your electronic signature (via filling in your name below) in connection with agreements and other communications has the same effect as an ink signature.
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Confirm that you are authorized to provide this consent on behalf of yourself and your minor.
Parent/Legal Guardian signature required for all assistants under the age of 18.
PARENT/GUARDIAN SIGNATURE:
DATE:
HOME PHONE:
OTHER PHONE:
CONTACT EMAIL: