Rider W/O Disabilities Membership Registration Form

Riders Without Disabilities Registration

Weekly commitment required!
Rider's Name *

First Name Last Name
Birth Date: *

Month Day Year
Estimated Weight *
Estimated Height *
Abilities: Please indicate if rider has previous riding experience. *
Parent (if under 18)/Rider Phone Number

Area Code Phone Number
Email Address *
Preferred day/time. Currently lessons are taught every day, including weekends
Emergency Contact

First Name Last Name
Emergency Mobile

Area Code Phone Number
Relation to Rider
Any known medical issues/concerns/reactions etc.
Thank you!
Should be Empty: