Bright Star Equestrian Centre
1450 Horse Farm Road, Divernon, IL 62530 217-741-3086
100% OF PROCEEDS GO TOWARD HELPING VETERANS AND INDIVIDUALS WITH DISABILITIES
We are donating to Sanctuary Hill Foundation, NFP to help provide Equine-Assisted Activities and Therapies for Veterans and children/adults with mental and/or physical disabilities.
Recreational Riding Lessons Registration Form
Updated 6/2019
Applicant's Name: *
Your answer
Gender *
Date of Birth *
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Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
County *
Your answer
Ethnicity *
We ask this in order to provide data for some of our grant funding partners. You may choose "prefer not to answer" if you prefer.
Required
Parent/Guardian's Name (If over 18, type your information.) *
Your answer
Parent/Guardian's Cell Phone Number (If over 18, type your information.) *
Your answer
Parent/Guardian's Employer (If over 18, type your information.) *
Your answer
Parent/Guardian's Email Address (If over 18, type your information.) *
Your answer
Parent/Guardian's Job Title (If over 18, type your information.) *
Your answer
Parent/Guardian's Work Phone Number (If over 18, type your information.) *
Your answer
Parent/Guardian's Preferred Method of Contact (If over 18, select your preferred method.) *
Other Parent/Guardian's Name:
Your answer
Other Parent/Guardian's Cell Phone
Your answer
Other Parent/Guardian's Employer
Your answer
Other Parent/Guardian's Job Title
Your answer
Other Parent/Guardian's Work Phone
Your answer
Other Parent/Guardian's Email Address
Your answer
Have you attended Sanctuary Hill before? *
If you are a new client, how did you hear about us?
Which day(s) are you most available for lessons? *
Required
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