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Leadership with Horses Session Registration
Participant Information Name Address
City State Zip Home Ph. Work Ph. Cell Ph. Email
Health and Safety Information
Year of last tetanus shot:
Are you allergic to bee stings?:
List known allergies:
List any medications you are taking that we should be aware of:
Any injuries we should be aware of?:
Name of emergency contact: Phone #: Relationship:
Name of contact person #2: Phone #: Relationship:
Other Information
• No horse experience is necessary and no riding is involved. • Safe horse handling practices are thoroughly reviewed with participants. • We will spend a great deal of time outdoors, so dress for the weather. We recommend layers, a hat and
sunscreen. • It is best to wear comfortable clothing that you do not mind getting a little bit dusty, perhaps even dirty. • Wear protective footwear. This means sturdy, closed-‐toe and closed-‐heel sneakers or boots. Do not wear flip-‐
flops or bare feet. • Do not wear anything that dangles and can get caught or tied up. • Please bring your own water bottle.