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You are here: Rider Registration and Release
Rider's Registration and Release
  1. First Name(*)
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  2. Middle Initial
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  3. Last Name(*)
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  4. Date of Birth(*)
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    (MM/DD/YYY)
  5. Phone(*)
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  6. Address(*)
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  7. City(*)
    Please enter the state where you live.
  8. State(*)
    Please enter the state where you live.
  9. Zip Code(*)
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  10. School or Institution presently attending(*)
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  11. Name of Parent or Legal Guardian(*)
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    (If you are an adult, input "none")
  12. E-mail address(*)
    Please enter a valid email address.
  13. Confirm e-mail address(*)
    Please confirm your e-mail address.
  14. Phone for parent or guardian(*)
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    (If you are an adult, input "none")
  15. Parent/Guardian Address
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  16. Address for parent or guardian
    (If different from yours)
  17. City
  18. State
  19. Zip Code
  20. Liability Release(*)
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  22. Digital Signature (Full Name)(*)
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    If under the age of 18, the parent/legal guardian must sign. This is a digital signature. By typing your name, you are signing this document.
  23. Photo Release(*)
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  25. Digital Signature (Full Name)(*)
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    If under the age of 18, the parent/legal guardian must sign. This is a digital signature. By typing your name, you are signing this document.
  26. Date(*)
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  27. WARNING: Under NC Law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. -Chapter 99E of the NC General statutes.
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  29. Submit Form