Registering for (please mark all that apply)
Membership
Membership (Monthly Renewal)
Volunteering
Horsemanship Riding
Little Buckaroos
Tiny Trailblazers
Animal Assisted Life Skills
Camp
Skills for Service
College Internship Program
For Riding Families:
Please note that ALL riding families must submit you Rider Manual and Payment Form to our office prior to your first lesson. If you need these forms, please email office@traktucson.org.
Parent/ Primary Adult Contact
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number:
*
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Parent/ Second Adult Contact
First Name
Last Name
E-mail
Phone Number
-
Area Code
Phone Number
Military Family?
*
Yes
No
Occupational Affiliations (Optional):
Special Skills (Optional):
Child or Youth Participant
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Additional Child or Youth Participant
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Required for each child
Additional Child or Youth Participant
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Required for each child
Special Notes for Staff to Consider
Emergency Contact #1
*
First Name
Last Name
Emergency Phone Number #1
*
-
Area Code
Phone Number
Alternative Emergency Contact #2
First Name
Last Name
Emergency Phone Number #2
-
Area Code
Phone Number
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Medical Information
Insurance information is required
Hospital/Clinic Preference
Physician's Name
*
Physician's Phone Number
*
-
Area Code
Phone Number
Insurance Company
*
You MUST have Insurance to participate
Policy Number
*
You MUST have Insurance to participate
Allergies
Nuts
Gluten
Casein
Soy
Lactose intolerance
Hay/Seasonal/Environmental
Allergies (any details you wish to add)
Does your child take medication? If so, what, and how often? Do any of the medications impact balance or judgment?
*
Write N/A if not applicable to your registration.
Are there any behavioral patterns or concerns we should know about?
*
Anything else that we should know about you or your child?
For Minor Child:
If parents are divorced, who has custody?
Mother
Father
Joint
Other
If yes, please let us know who is the responsible party for TRAK invoices?
Anything else regarding child guardianship?
Whom may we thank for your referral?
Where did you hear about TRAK?
*
Social Media
Web Search
School
Counselor
TV
Word of Mouth
Yelp
Other
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Next
Release of Liability and Waiver
This form is mandatory.
*
List all participants covered by this liability release
*
Waiver Signature
*
Date
*
-
Month
-
Day
Year
Date
Photo Release
*
Yes-unrestricted
No-deny permission
Photo Release Signature
*
Date
*
-
Month
-
Day
Year
Date
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Demographic Information
TRAK relies on grants to support its programs. Grantors frequently ask us for the following information, and your response is completely optional. Thank you!
Ethnicity
*
Prefer not to answer
White
Black or African-American
Asian
Native American
American Indian or Alaskan Native
From multiple races
Household income
*
Less than $10,000
$10,000-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000-$149,999
$150,000 or greater
Prefer not to answer
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