MINDFUL DRESSAGE CLINIC FORM 

CLINIC LOCATION    

CLINIC DATE    

 

FULL NAME     _______________________________________________________________

 

ADDRESS       _________________________________________________________________

 

 

 

PHONE  #_____________________________

 

 EMERGENCY #______________________________

 

EMAIL ADDRESS   ______________________________

 

LEVEL HORSE/RIDER ________________      PRIVATE             $ 95.00

                                                                                 

 AUDIT ________ $35.00                                    SEMI PRIVATE    $ 70.00

 (Walk ins call day ahead to order lunch)

 price includes lunch & a drink                            TOTAL $ _____________

                                                                                                                                        

COPY OF NEGATIVE COGGINS REQUIRED

CHEQUES PAYABLE TO – YVONNE ATWOOD.

MAIL TO - P.O. Box 271, Myersville, MD 21773. 

Call Yvonne @ 240  529-8707 for questions & late lunch orders.

POSSIBLE STABLING  –  Contact

Ride times emailed Thursday before clinic. Call Yvonne if 'last minute'. Please read & sign the following disclaimer of liability -

I, the undersigned, understand that horse riding is a high risk sport and fully accept the risks involved as a rider, horse owner and an auditor at a lesson, clinic or any other horse activity conducted by Yvonne Atwood; and I, the undersigned, hereby release, waive and discharge any right to sue Yvonne Atwood (Mindful Dressage), her heirs and next of kin, or assistants; and I hereby agree to indemnity and save and hold harmless the releasee, and each of them, from any loss, liability, damage or cost that she/he may incur due to my presence in or about said activities, whether caused by the negligence of the releasees or otherwise.

 

PRINT NAME _________________________________

 

DATE  __________________________

 

SIGNATURE  ________________________________________________