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Rider's Registration and Release

First Name(*)

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Middle Initial

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Last Name(*)

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Date of Birth(*)

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Phone(*)

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Address(*)

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City(*)

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State(*)

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Zip Code(*)

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School or Institution presently attending(*)

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Name of Parent or Legal Guardian(*)

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E-mail address(*)

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Confirm e-mail address(*)

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Phone for parent or guardian(*)

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Parent/Guardian Address

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Address for parent or guardian

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Liability Release(*)

I would like to participate in the CAN-TR program. I acknowledge the risks and potential for risks of a horseback riding program; however, I feel that the possible benefits to me/my child/my ward are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against CAN-TR, its member farms, its Board of Directors, instructors, therapists, volunteers and/or employees for any and all injuries and/or losses I/my child/my ward may sustain while participating in the programs of CAN-TR and its member farms.Invalid Input

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.
Photo Release(*)

I do I do not consent to and authorize the use and reproduction by CAN-TR of any and all photographs and any other audio/visual materials taken of me for promotional material, educational activities, exhibitions, or for any other use for the benefit of the program.Invalid Input

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.
Date(*)

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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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