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You are here: Therapeutic Riding Contract
Therapeutic Riding Contract
  1. Date(*)
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    (Effective for one year)
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  3. Access the terms and conditions here
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  5. RIDER INFORMATION
  6. First Name(*)
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  7. Middle Initial
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  8. Last Name(*)
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  9. Age(*)
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  10. Date of Birth(*)
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    (MM/DD/YYY)
  11. Phone(*)
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  12. Address(*)
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  13. City(*)
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  14. State(*)
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  15. Zip Code(*)
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  16. Home Phone(*)
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  17. Work Phone
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  18. Mobile Phone
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  19. E-mail address(*)
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  20. Confirm e-mail address(*)
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  21. Name of Parent or Legal Guardian(*)
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    (If you are an adult, input "none")
  22. Phone for parent or guardian(*)
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    (If you are an adult, input "none")
  23. Parent/Guardian Address
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  24. Address for parent or guardian
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  25. City
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  28. Name of Emergency Contact(*)
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  29. Relationship to you(*)
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  30. Phone for emergency contact(*)
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  31. Cost/Financial Assistance(*)



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  32. Initial Here(*)
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  33. ACCEPTED BY
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  36. I am the(*)
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  37. 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.
  38. 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.
  39. Witness:
  40. Digital Signature (Full Name)(*)
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    Must be 18 years of age or older to sign. This is a digital signature. By typing your name, you are signing this document.
  41. 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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