Name

Address

City StateZip

email

Phone Home

Phone Work

Date of birth (xx/xx/xx)

Place of birth

US Citizen

Age

Height

Sex

Physical Defects

TETANUS SHOT REQUIRED! 

In Case of emergency, notify: 

Name                

Address             

Phone                 

Phone                 

Medical Ins        

If under 21 both parents must sign: 

Date

PLEASE USE ANOTHER SHEET OF PAPER FOR ADDITIONAL INFORMATION AND
(SNAIL) MAIL IT TO US! 

Education: Years/Name and Address of School/Field of Study 

High School

Trade School

College

Horse Experience

NO EXPERIENCE NECESSARY!

Employer

Enrollment fee $100.00 with application non-refundable.   

I affirm that all information given in this application is true to the best of my knowledge. 
I will assume and accept all responsibility for any accident or injury which I may suffer during the time of
enrollment, as well as any compensation time. I further release and discharge LOOKOUT MOUNTAIN SCHOOL OF HORSESHOEING, its owners, instructors, horse owners, and any landowner in which a
class or training is taking place, in all suits, actions, and all causes of act, under the terms herein set forth. 
Class Date

Check one of the following; 

 2 week course 

OR 8 week course_______ 

Any questions, call Lookout Mountain at: (256) 546-2036 
or email Tom at tmcnew@microxl.com