Ride For The Ranch Health Form
For minor participants without a parent/guardian present at the event
Email address
Parent/Guardian(s) Name(s)
Your answer
Participant's Full Name
Your answer
Participant's Date Of Birth
MM
/
DD
/
YYYY
Emergency Contact(s) and Phone Number(s). Please list multiple.
Your answer
Insurance Company and Policy Number
Your answer
Family Doctor and Office Number
Your answer
Date/Year of last Tetanus Booster
Your answer
Medications Taken Regularly and Dosages (n/a if not applicable)
Your answer
Does the participant have any Current Infectious Diseases?
Allergies/Other Medical Concerns (n/a if not applicable)
Your answer
I have verified that this Health History is correct to my knowledge: (type in Full Name)
Your answer
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