Cowtown Horseshoeing School Enrollment Application (Please Print this Page) APPLICATION IS HEREBY MADE FOR THE UNDERSIGNED ON TERMS DESCRIBED BELOW. I UNDERSTAND THAT THE SCHOOL MAY ACCEPT OR REJECT THE APPLICATION WITHOUT NOTICE OR EXPLANATION. NAME: (Please Print) _____________________________________________________________________________________ ADDRESS: ______________________________________________________________________________________________ CITY: ______________________________________________STATE:_________ ZIP:________________________________ TELEPHONE: ________________________________________ SOCIAL SECURITY NO.: __________-______-____________ AGE: (Optional) ___________________________ SEX: (Optional) _________________________________________________ REQUEST ADMISSION FOR CLASS BEGINNING: _____________________________________________________________ WHO REFERRED YOU TO THE SCHOOL: (Magazine, etc.) ______________________________________________________ EDUCATION: (YEARS - NAME & ADDRESS OF SCHOOL - FIELD OF STUDY) HIGH SCHOOL: __________________________________________________________________________________________ TRADE SCHOOL:_________________________________________________________________________________________ COLLEGE: ______________________________________________________________________________________________ PLEASE LIST EXPERIENCE WITH HORSES: (None Required) __________________________________________________ _______________________________________________________________________________________________________ NAME OF EMPLOYER: ___________________________________________________________________________________ ADDRESS OF EMPLOYER: _________________________________________________________________________________ YOUR DUTIES: __________________________________________________________________________________________ BY SIGNING HERE I AFFIRM THAT ALL INFORMATION GIVEN IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE. I ASSUME AND ACCEPT ALL RESPONSIBILITY FOR ANY ACCIDENT OR INJURY WHICH I MAY BE INVOLVED IN WHILE ATTENDING SCHOOL, ON OR OFF THE PREMISES, OR FOR ANY FINANCIAL OBLIGATIONS ENTERED IN TO BY ME WHILE ATTENDING THE SCHOOL. I FURTHER RELEASE AND DISCHARGE COWTOWN HORSESHOEING SCHOOL, ITS OWNERS, INSTRUCTORS, HORSE OWNERS, AND LAND OWNERS IN WHICH ANY CLASS OR TRAINING IS TAKING PLACE. SIGNATURE OF APPLICANT: _______________________________________________ DATE: __________________________ IF UNDER 18 BOTH PARENTS OR GUARDIANS MUST SIGN HERE: _____________________________________________ ________________________________________________________________________ DATE: __________________________ IN CASE OF EMERGENCY NOTIFY: ________________________________________________________________________ ADDRESS: ______________________________________________________________PHONE: _________________________ CURRENT TETANUS SHOT IS REQUIRED. PLEASE LIST DATE OF LAST IMMUNIZATION: ________________________

RETURN THE COMPLETED APPLICATION FORM ALONG WITH THE $500 DEPOSIT TO: COWTOWN HORSESHOEING SCHOOL MERLIN ANDERSON, DIRECTOR P.O. BOX 841 MILES CITY, MT 59301