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.Format: (000) 000-0000.

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.Format: (000) 000-0000.

Riding Experience Level

Preferred Lesson Days/Times

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

Is the student under 18 years old?

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

Signature (Parent/Guardian if under 18)