Adult Registration

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Adult Registration

Please complete both of the following sections below.

Email *

Full Name (First & Last) *

Date of Birth *

YYYY

Age *

Gender *

Male

Female

Prefer not to say

Other:

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: *

Home

Mobile

Work

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 *

0 - Never been on a horse before

1 - Walk

1a - Begginer Trot

2 - Trot

3 - Beginner Canter

4 - Canter Comfortably

5 - Small Jumps

6 - Intermediate

7 - Advanced

Provide any notes pertaining to previous riding experience.

Preferred Lesson Format. *

Introduction to Riding (2-1 Hour Lessons $130)

Half Hour Private ($65)

Full 45 Minute Private ($95)

1 Hour Group Lesson 2-4 riders ($80/rider)

Beginner Private ($80)

Beginner Group 2-4 riders ($70/rider)

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.

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This form was created inside of Whitchurch Riding Academy.