Horse Registration Form

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SULLIVAN CANYON PRESERVATION ASSOCIATION

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Please fill out this form to register a horse(s) with the SCPA and return it with your biannual dues payment. This registration must be completed entirely. Do not skip any lines, even if some information is already on file.

You are required to attach a photo of the horse and its most recent vaccination certificate. SCPA requires that all horses are regularly vaccinated for EHV and EIV at the very least. Failure to do any of the above will be penalized

Please Complete the Following:

Today's Date*

First name*

Last name*

I am the horse's *

Owner

Lessee

Rider

Email*

Phone*

Home Address*

Emergency Contact Name*

Emergency Contact Number*

Payor’s Email Address for Horse SCPA Fees*

Trainers that train you or any of your horses at SCPA site (select all that apply).

Alex Chasen

Cha Cha Levinson

George Bittar

Kathy Megla

Jodi Spurgeon

Nicole Husky

Traci Brooks

Frederico Bernardino

Michael Andersen

Total Number of Horses You Own and/or Lease to Others at SCPA: *

Please complete a separate Horse Registration Form for each horse that you own and/or lease to others that is registered to use SCPA facilities and for which you pay SCPA Horse Use Fees.

Select "Active" to register a current horse or add a new horse. Select "Delete" if you wish to remove a horse from SCPA records.

Barn Name*

Show Name

Microchip Number*

Breed*

Color*

Special Markings

Stable Owner Name*

Stable Owner Number*

Stable Owner Address*

Stable Owner Email*

Status

Active

Delete

Upload Horse Photo*

By completing and submitting this registration, I agree that the SCPA is not liable for any injury or illness, including death, of any horse and me, the rider, at the SCPA site for any reason, and I waive any and all claims and indemnify SCPA.

You may download this form HERE

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Sullivan Canyon Preservation Association

1640 Old Oak Road Los Angeles, CA 90049

(310) 454-5905

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