Recreational Riding Classes Registration Form Note: If you have difficulty with the date fields, try entering the dates in YYYY-MM-DD format. Name (required) Date of Birth Age Height Weight Riding Preference EnglishWestern Address (Street) Address (City) Address (State) Address (Zip) Phone Email (required) Parent / Guardian Name Parent / Guardian Relationship Parent Address (Street) Parent Address (City) Parent Address (State) Parent Address (Zip) Phone (Home) Phone (Work) Phone (Cell) Email Preferred method of contact: Home PhoneWork PhoneCell PhoneEmail May we email you? Select the items you'd like to receive: NewslettersProgram informationSurveysVolunteer opportunitiesFundraising events How did you hear about us? FriendRelativeNewspaperFlyerOther (describe below) If other, please describe: Liability Release I acknowledge the risks and potential for risks for horseback riding and related equine activities including grievous bodily harm. However, I feel that the possible benefits to myself 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 Victoria Acres Equine Facility, Inc. its Board of Directors, instructors, therapists, aides, volunteers and /or employees for any and all injuries and/or losses I (my child) may sustain while participating at a Victoria Acres Equine Facility program from whatever cause including, but not limited to, the negligence of these related parties. The undersigned acknowledges that he/she has read this Registration and Release form in its entirety; that he/she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof. Signature Date Parent or Guardian's Signature (required if participant is under 18) Date Please complete all required fields and check the liability release box before sending.