GOOD GROUND MINISTRIES
CLINIC REGISTRATION
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Email *
Location  *
First Name *
Last Name  *
Address *
City *
State *
Zip Code *
Phone number *
Participant or Auditor *
There is a $150 NON REFUNDABLE Deposit due at the time of registration.  *
Required
Method of Payment -  *
 Checks made payable to Cathy Hollabaugh or Good Ground Ministries and send to 309 Sanders Road, Denton TX 76210.     PayPal email: goodgroundministry1@gmail.com
Will anyone else be coming with you to the clinic? (Food count purposes)  *
If yes to the previous question, how many will be coming with you?
Do you have any special dietary needs? *
Amount Paying Today *
(How did you hear about Good Ground?)
Indemnification and Release Personal Injury: By signing this document I hereby agree to hold harmless Good Ground Ministries, its agents, management, contractors, and employees from any expense, cause of action, damage, or claim of damage, including legal fees of any kind, which I might assert as a result of my (or my child’s) injury, death or claim by participating or driving to or from this event. I further certify that I have available a current NEGATIVE EIA TESTCHART on each animal I have on the event grounds. I understand that if State and Local Authorities require presentation of said test chart at this event and I cannot present a NEGATIVE EIA TEST CHART per any one (1) animal, I will be responsible for any fines personally, and will be responsible for reimbursement of any fines to the event producer. YOUR SIGNATURE CONSTITUTES A RELEASE OF LIABILITY (If Minor, Parent or Guardian). *
A copy of your responses will be emailed to the address you provided.
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