Adult Registration
Please complete both of the following sections below.
Sign in to Google to save your progress. Learn more
Email *
Full Name (First & Last) *
Date of Birth *
Age *
Gender *
Contact Information
Address *
City *
Province *
Postal Code *
Phone Number (Please include extension if applicable) *
Please select the option which best applies to the phone number listed above: *
Emergency Contact Information
Who is the best person to contact in case of emergency?
Name *
Relation to the Rider *
Phone Number *
Medical Information
Please answer the following questions to the best of your knowledge. If you answer yes to any of the questions, please provide a brief explanation.
Do you suffer from allergies? *
Are you undergoing any medical treatments? *
Health or behavioural conditions that we should be aware of? *
Do you carry any medications? *
Please provide any other additional health related information which may be important for us to be aware of.
Lesson Registration Level
Riding Level *
Provide any notes pertaining to previous riding experience.
Preferred Lesson Format. *
What is your preferred day of the week you would like to ride? *
Preferred Time of day (Please note that lessons Monday through Friday begin at 12pm) *
Please provide any additional notes about your registration.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Whitchurch Riding Academy. Report Abuse