Parent/ Adult Name *

First Name

Last Name

Parent/ Adult Phone *

(###)

###

####

Child 1 Name (if applicable)

First Name

Last Name

Child 2 Name (if applicable)

First Name

Last Name

Child 3 Name (if applicable)

First Name

Last Name

Child 4 Name (if applicable)

First Name

Last Name

SELECT A TIME SLOT FOR HORSEBACK RIDING (ONLY SELECT ONE)

Selecting a timeslot helps us to prepare for the number of participants we will have each hour. While numbers will not be exact, providing this information will help to decrease wait times for horseback riding.

10:00am - 10:30am

10:30am - 11:00am

11:30am - 12:00pm

12:00pm - 12:30pm

12:30pm - 1:00pm

1:30pm - 2:00pm

2:00pm - 2:30pm

2:30pm - 3:00pm

ELECTRONIC SIGNATURE OF PARTICIPANT/PARENT OR GUARDIAN: *

By typing my name below, I acknowledge that I am providing an electronic signature that is legally binding and serves as the equivalent of a traditional wet signature. I understand that my electronic signature will be used to signify my consent to the terms and conditions of this Waiver and Release of Liability for "Saddle Up for Autism: A Day of Connection," and I consent to the use of my electronic signature for all purposes related to this document.

First Name

Last Name

IF PARTICIPANT (S) IS UNDER 18 YEARS OLD:

I, the undersigned parent/legal guardian of the minor named above, do hereby consent to their participation in the event and agree to the terms and conditions of this Liability Waiver and Release of Liability.

First Name

Last Name