ONLINE LESSON REGISTRATION FORM

Draft of our upcoming lesson schedule is now underway.
Please advise us of your day and time preferences.
New students please complete all fields.

 
Day/time preferences:
Please indicate day and time preferences. Please include dates and times that would not suit your schedule.		  
 
       
Participant's Name:   Gender:
 
     
 
City of Residence:
Year of Birth:
 
Phone #:
 
     
       
       
Parent/Guardian1:    
( Adult students please use this section to provide an emergency contact person. )  
City:    
Home Phone #:    
Work Phone #:    
Cell Phone #:    
Email:    
       
Parent/Guardian2:    
City:    
Home Phone #:    
Work Phone #:    
Cell Phone #:    
Email:    
       
       
How long has student been riding?  
       
Riding Experience - please check all that apply:    
Walk   Trot Canter  
Jump Eventing Other:
       
How many times have you fallen off your mount?
 
     
Please list previous barns where you have received riding instruction:  
Barn: Instructor:
Barn: Instructor:
       
     
Aspirations - briefly note short and long term goals:  
     
Special notes:    
     
Is there critical medical information that OOF needs to be advised of?
     
             

Finally, please read the following waiver thoroughly.

Acceptance of Risk Agreement I request permission to participate in horseback riding and other activities at Old Orchard Farm. I fully understand that horseback riding, handling and grooming of horses and other stable activities are very dangerous. I wish to participate in these activities knowing that they are dangerous. I accept and assume all the risks of injury (including death) to myself or my property.

       
       
I agree.