Ritter Clinic Forms & Release

Registration Form

Classical Dressage Clinic with Dr. Thomas Ritter

Please print clearly

First Name ____________________Last Name_______________________Date____________

Home Address_______________________________________________City _______________

State_____Zip Code ___________Ph___________________ Email_______________________

Name of Horse______________________Current level of training (horse)___________________

Breed of Horse______________________Age of horse_____________________

Preferred days (circle) Friday AM - Friday PM - Saturday AM - Saturday PM - Sunday AM – Sunday PM

All lesson are on a first come basis must be paid in full to hold your spot.

$____________Private lesson $155 number of lessons______

$____________Semi-private $90 number of lessons______

$____________Auditors $10 per day

$____________Stabling $35 per day number of nights______

Total Enclosed $___________

EMERGENCY CONTACT INFORMATION

In Case of Emergency Notify:

Name ___________________________________Relation______________________________

Phone (Home)_____________________(Work/Cell)________________________________

 

In Consideration of being permitted by Melanie & Tom Adams & Four Winds Farm., (the Clinic/Farm) to enter onto the premises and participate in a program or activity. I hereby agree that I, my assignees, heirs, distributes, guardians, their legal representatives will not make a claim against, sue, or attach the property of where the clinic will be held in addition to Melanie Adams, York IEO, MDA, & any of its sponsors, clinicians, or any of their principals, agents, employees or representatives, for injuries or damages resulting from the negligence or other acts, conditions, or circumstances, howsoever caused, by any principal. Agent, employee, clinician, or representative of Four Winds Farm and its sponsors or its representatives. From all actions, claims, or demands that I, my assignees, heirs, distributes, guardians, or legal representatives now have or may hereafter have for injury or damage resulting from my presence at The Clinic or from my participation in a program or activity at The Clinic.

____________________________________________Signature_____________________Date

Please send your completed registration form and payment (checks payable to Melanie Adams ) mail to:

Melanie Adams

5157 Jolly Acres Road

White Hall, MD 21161

443-220-6058

Donations will be collected and provided in honor of Laura Johansson to:

Equine Assisted Therapy and Handicapped Riding of New Jersey

c/o Jeanne Mahoney

DREAM Park of Gloucester County

400 Rte 130 South, Logan Township, NJ 08085

Future Classical Dressage Clinics with Dr. Thomas Ritter:

There will be additional 2009 clinic dates in New Jersey and Maryland.

Please check Dr. Ritter’s calendar for more information www.artisticdressage.com