Name
Date of Birth
Mailing Address
City, State, Zip
Student Email
Parent's Names: (father)
(mother)
Phone: Cell
Cell
Home
Home
Work
Work
Emergency Contact
Phone
Health Insurance Information
Name of Policy Holder
Policy Holder Address
Insurance Company
Policy No.
Phone
Doctor
Hospital
Allergies
Phone
Level of Riding Experience
(Significant influence of horse such as collection & flying changes)
(Walk, Trot, Canter, Jump to 2'6")
(Little or No Experience)
(Has or is competing at any level)
Number of years riding
Sessions Desired
June 8-12
July 20-24
June 22-26
June 29 - July 3
June 15-19
July 13-17
July 6-10
July 27-31
August 3-7
August 10-14
August 17-21
Extended hours if required:
Early Drop Off Time
Late Pick Up Time
T-Shirt Size
Special Instructions
Student Phone
Parent Email
IMPORTANT!!! Parent Email is the primary source of communication!
