Hunter Pace Entry Form
Select Division:
Team Mate Name(s):
Your answer
Waiver Acceptance and Signature: *
To view and read the waiver please click the link on our website
Required
Electronic Signature *
Please type your first and last name
Your answer
Electronic Signature for a minor
Please type your first and last name of parent or legal guardian
Your answer
Rider Information
Name of Rider *
First name
Your answer
*
Last name
Your answer
E-mail address
Your answer
Mailing address
street
Your answer
city
Your answer
state
Your answer
zip
Your answer
Emergency Contact Information *
Please list emergency contact name
Your answer
*
Phone number
Your answer
*
Relationship
Your answer
Please list any known medical conditions that may be pertinent in case of an accident
Your answer
How did you hear about our Hunter Pace?
Please check all that apply
Would you like to be added to our email list and receive notifications of other available events?
Please note that we DO NOT share your information with ANYONE and the notices will be limited to Glenmore Hunt activities and events.
Horse Information
Name of Horse *
Your answer
Coggins Accession # *
(please bring a copy to the event if not sent in at the time of registration)
Your answer
*
Date blood drawn
Your answer
*
State blood drawn
Your answer
Horse owner
Name
Your answer
Address
Your answer
Phone number
Your answer
Email
Your answer
Method of Payment
Please select your method of payment below. Note the Credit Card and PayPal link is on our website. Payment method must be received by Friday November 16. For questions regarding payment, contact the event coordinator Cindy Kiser 540.255.2208 or Horse Activities Chair Angelika O'Donnell 540.249.4200
What method of payment will you be using?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.