Application of Enrollment to the NCMP

 

 

 

Full Name:  ________________________________________________________________________________

 

Address:     _____________________________ City_________________________ State & Zip ____________

 

Home Number ___________________________                       Work Number ___________________________

 

Cell Number    ___________________________              E-Mail            ___________________________

 

Date of Birth   ___________________________                       

 

Emergency Contact # _____________________                        Relationship   ____________________________

 

Employment ____________________________

 

 

 

 

 

Do you have your own horse, tack, and transportation?  ______________________________________________

 

Is your Application for  RIDING  or  NON-RIDING  ________________________________________________

(If  RIDING, please include a current copy of coggins with application)

 

Tell us why you are interested in riding with the Nacogdoches County Mounted Patrol?  ____________________

 

___________________________________________________________________________________________

 

___________________________________________________________________________________________

 

 

 

Release of Responsibility

I understand by signing this application that I will ride at my own risk and with the understanding that neither this organization or any member thereof, or any premise owner where the Organization rides shall be held responsible for any injury to person, mount, or equipment incurred while participation in any activity of this Organization.

 

 

 

 

       _____________________________   ________________________________   ________________

                        Print Name                              Signature                  Date

 

 

Date Application received ___________________________   Received by ____________________________

 

Date:   APPROVED  or   DISAPPROVED  _____________