Cyril Pittion-Rossillon Clinic

Name *

First Name

Last Name

Guardian's Name

For riders under 18

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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What clinic(s) are you entering? *

November 15th - 16th

January 17th - 18th

February 28th - March 1st

What day(s) would you like to ride? *

Saturday, November 15th

Sunday, November 16th

Saturday, January 17th

Sunday, January 18th

Saturday, February 28th

Sunday, March 1st

What type of session would you like? *

Jumping

Dressage/Flat

Both

Private or Semi-Private *

Private

Semi-Private (2 riders)

Horse Information: *

Mare

Gelding

Stallion

Stabling Requests *

Haul-In Only

11/14, Friday Evening

11/15, Saturday

11/16, Sunday

1/16, Friday Evening

1/17, Saturday

1/18, Sunday

2/27, Friday Evening

2/18, Saturday

3/1, Sunday

WARNING: Each participant who engages in an Equine Activity expressly assumes the risks of engaging in and legal responsibility for injury, loss or damage to person or property resulting from the risk of equine activity. I understand that this is a high risk sport and I am participating at my own risk. I hereby release and hold harmless Scenic River Farms, its owners and employees, attendants, spectators, organizers, volunteers, and all others involved from all liability for accidents, damage, injury, or illness sustained or caused as a result of my participation in this clinic. *

Agree