Group Winter Session

Group Winter Session Registration

January 2nd-February 11th (6 weeks) $684
**A $30 enrollment fee is required for new students. You can pay this through paypal or by check.**
Lessons are for one hour once a week.
Please select the days you are available (subject to instructor availability): *

Monday Tuesday Wednesday Thursday Friday Saturday (MORNING ONLY)
Please select the earliest time you could arrive at the barn: *

2:30 3:30 4:30 5:30
Student Information
Student's Name *

First Name Last Name
Birth Date *

Month Day Year
Gender

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Information
Name *

First Name Last Name
Cell Number *
E-mail *
example@example.com
Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship
Phone Number *
Alt. Phone Number
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the student prescribed an inhaler? If yes, please explain any instructions. *
New Student Enrollment Fee *
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Pay with PayPal
$ 30.00

Pay with check Add $30 to you session total
Free

Total

$ 0.00
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Group Winter Session Registration