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Clinic Registration Form
238 Prescott Rd Manchester, ME 04351 207-623-1152 - email: jacqui@treasureeques.com or jacquibyron@yahoo.com Clinic: ________________________________ Date(s): ________________ Name: ______________________________________ Address: ____________________________________ ____________________________________________ Tel: _______________Alt Tel: ________________ Age: Youth __ Adult __ Horse: _________________________________ Breed: ____________________ Age: _________ Level of Horse: __________________ Level of Rider: _________________ # of rides: __________ Cost: __________ Amount enclosed: ___________ Stalls: __________ Cost: $25.00 per day/$35 overnight: Amt. Encl. ______ Total Amount Enclosed: _______________ Neg. Coggins & shot record enclosed: ______________________________ |