Clinic Confirmation

Thank you so much for registering for our clinic at Panther Creek!

As a final step, please fill out our Equine Release Form, listed below.

We will see you soon!

Panther Creek Equine Waiver

Please review our Equine Release Form.

Date

Name of Person Filling Out Form

First Last

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Date of Birth

Are you the Participant?(Required)

Yes

please fill out all information for the minor child in your care or custody.

Minor's Name

First Last

Minor's Date of Birth

Is anyone else authorized to drop off or pick up your minor child from Panther Creek? If so, please list here.

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Signature

Phone

This field is for validation purposes and should be left unchanged.