CANDICE KING Clinic Registration Form

Rider’s Name ______________________________Age_________

Address________________________________________________

_________________________________________________

Day Phone:_________________________ Evening Phone:___________________________

Email:____________________________________________

Stabling: Yes_______ No________ Fri_____ Sat____ Both_____

Highest Eventing level rider has completed:

Highest Eventing level horse has completed:

Pony Club Rating, if applicable:

Please circle choice of level: BEG-NOVICE NOVICE

TRAINING PRELIMINARY PRELIM/INTERMEDIATE

INTERMEDIATE

CLINIC FEE: $395 ; the entire clinic fee must be included or it will not be accepted

AUDITING FEE: $15/ONE DAY: $25/BOTH DAYS:

Name(s) of auditor(s):

Name of ‘free’ auditor; one per clinic participant:

Stablng: no yes amount included: $_____________

Saturday Night dinner: no yes ______total number at $15 each: $__________

Cancellation policy: I understand that the clinic fee of $395 is non refundable, that I am purchasing a time slot which must be paid for in advance. If I am unable to use this space I am responsible for finding another rider to fill it; Waredaca will also maintain a wait list for unforeseen circumstances.

Signature:________________________________(parent must sign if rider is under 18 years of age)

Make checks payable to WAREDACA/ CANDICE KING Clinic

and mail with completed application to:

Waredaca/ CANDICE KING Clinic 4015 Damascus Rd Laytonsville, MD 20882

As a reminder, have you:

__completed application including all signatures and necessary information

__enclosed full payment of clinic, auditing, stabling if desired and optional Saturday dinner fees: $__________

__enclosed copy of a negative coggins test within 12 months

__identified the name of any auditors; you can call the office with this at a later date

Additional clinic info will be mailed in EARLY AUGUST to each participant.