Clinic Registration Form

9345 NW Elm Mills Rd, Cloats, KS 67028   866-672-5631   www.kerrykuhn.com

RIDER'S INFORMATON

Would you like to be added to our mailing list?

HORSE'S INFORMATON

Proof of a negative Coggins and current vaccinations must be provided before being allowed to participate in a clinic.

RELEASE, ASSUMPTION of RISK & INDEMNITY AGREEMENT MUST BE SIGNED AND MAILED PRIOR TO CLINIC!

Click         for printable Clinic Registration Form and Waiver.  Waiver MUST be signed and mailed, faxed, or scanned & e-mailed prior to clinic.

here

Clinic Location:

Clinic Dates:

Rider's Name:

Address:

Evening Phone:

City, ST, Zip:

Day Phone:

If YES, e-mail address:

Rider's Background &

Experience Level:

Horse's Name:

Horse's Age:

Horse's Sex:

Horse's Breed:

Horse's Background &

Training Experience:

What improvements or

changes would you like

to see in your horse?

Click here to return to

Registration Page.

YESNO