SPRING 2024 INVITATIONAL Registration

It is the policy of Ace High Roughstock Academy to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

If you have any questions, concerns, or difficulties, please email us at acehighroughstockacad@gmail.com. Thank you for completing this registration form and for your interest in riding with us.

Name

First Name

Last Name

Age

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Reference

How did you hear about us?

Discipline

Please select the discipline(s) you already know, or would like to learn.

Experience

How would you describe your level of experience?

Beginner - have been riding for less than 1 year

Intermediate - have been riding for 1-2 years

Experienced - have been riding for at least 3 years

Permit

Do you have a PRCA Permit?

Yes

Schools

Please select which school(s) you would like to register for.

Emergency Contact Name

Person to notify in case of emergency

First Name

Last Name

Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone

(###)

###

####

Medical Conditions and/or Allergies

Do you have any known medical conditions or allergies? If yes, please explain.

Medical Insurance Carrier

This information is used in case of an emergency.

Policy Number

This information is used in case of an emergency.

Agreement of Application

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a rider, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Agree