Student Information Form

Student’s Name (First and Last)

Student’s Birthdate

Will You Require a Helmet or Boot Rental?

Boot Rental ($15/month) Helmet Rental ($10/month)

Parents Name (If rider is 18 years or younger)

Address

Email address

Phone Number

Alternate Phone number

Students Past Experience with horses (beginner, advanced, etc)

Where previous lessons were taken (if applicable)

Emergency Contact

Emergency Contact Number

Dr’s Name

Dr’s Phone Number

Personal Health Number

Permission to Post Photos on Social Media (Yes or No)

How did you hear about us?

Preferred Method of Payment?

Other Details