Riding Lesson Admission Form

Student Full Name*

First NameLast Name

Date of Birth*

Date

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Home Address*

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

BeginnerIntermediateAdvancedNo Experience

Please list any medical conditions, allergies, or physical limitations we should be aware of*

YesNo

If the student is under 18, please provide parent/guardian name and contact information

Signature (Parent/Guardian if under 18)*