Rider Information Online Form

RIDER INFORMATION FORM

NAME: ________________________________________ DATE: ____________________
ADDRESS: ________________________________________________________________
CITY: _________________________ZIP: _______E-MAIL: ________________________
PHONE: (_____)_____________________ WORK: (_____)_________________________
OTHER PHONE NUMBER: (_____)____________DATE OF BIRTH: _____/_____/_____
Do you have health insurance? Y/N What company? ________________________________
Contact in case of emergency (name + phone #): ___________________________________
Medical concerns/conditions:___________________________________________________

RIDING EXPERIENCE:
How long have you been riding? _____Level of riding: Beginner/ Intermediate/ Advanced
Trail Rides Y / N
Lessons Y / N - if yes please indicate level and discipline below:

ENGLISH Y / N LEVEL: _______________________________
DRESSAGE Y / N LEVEL: _______________________________
EQUITATION Y / N LEVEL: _______________________________
HUNTER/ JUMPER Y / N LEVEL: _______________________________
WESTERN Y / N LEVEL: _______________________________

DO YOU OWN YOUR OWN EQUIPMENT?
Tack (Saddle / Bridle) Y / N Other: ___________________________________________
Riding Apparel (Helmet/ Boots/ Chaps/ Breeches) Y / N Other: _______________________

*We require at least 48 hours notice of cancellation or we charge you the full amount (initial)_____

FOR INSTRUCTORS USE ONLY:

Discipline desired to learn

Lessons

Camp

Boarder

TR