Horsemanship Lessons

1 Camper / Contact 2 Horse Experience 3 Waivers & Conditions 4 Payment

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Rider #1 Information

First Name *

Last Name *

Gender *

Birth Date *

Month

Day

Year

Rider #2 Information

First Name *

Last Name *

Gender *

Birth Date *

Month

Day

Year

Parent/Guardian 1

First Name *

Last Name *

Relationship to Camper *

Cell Phone *

Work Phone

Extension

Email *

Parent/Guardian 2

First Name

Last Name

Relationship to Camper

Home Phone

Cell Phone

Work Phone

Extension

Emergency Contact

Different from Parents/Guardians

First Name *

Last Name *

Relationship to Camper *

Home Phone *

Cell Phone

Work Phone

Extension

Medical Information

Does the camper have any allergies? *

Yes

Please Explain

Are there any medications UNSAFE for the camper? *

Yes

Please Explain

i.e. Penicillin

Please Explain