Buckaroo Winter Session Registration

Group Spring Session B

March 24thh- May 24th (9 weeks) $1,305 ($435/month)
Lessons are for one hour once a week.

**A $30 enrollment fee is required for new students. You can pay this through paypal or by check.**
Please select the days you are available (subject to instructor availability):*

MondayTuesdayWednesdayThursdayFridaySaturday (morning only)
Please select the earliest time you can arrive at the barn:*

2:303:304:305:30
Student Information
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade
Gender

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

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

First NameLast 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*
prevnext( X )
Pay with PayPal
$30.00



Pay with checkAdd $30 to you session total
$ Free



Current Student
$ Free



Total

$0.00
Should be Empty:

Group Spring Session B