Fall Buckaroo Club Lesson Registration

September 6th-December 18th (14 weeks)

There will be no lessons November 22nd-27th. We will be having a Thanksgiving Holiday camp.
Buckaroo Club lessons once a week: $560 (payment plan $140/month)
Select the students riding experience: *

Beginner (1st time lessons) Completed 1 year of lessons Completed 2 years of lessons Completed 3+ years of lessons
Select days YOU are available to ride: *

Monday Tuesday Thursday Friday Saturday (MORNING ONLY)
Select times YOU are available to ride: *

Morning Afternoon If you need a lesson after school please provide the earliest time you could ride in the box marked other.
If you are a new student, we do require a $30 registration fee. You can pay this through PayPal or by check. (We won't be able to accept regular lesson payments through PayPal.)
prev next ( X )
New Student Registration Fee $ 30.00

Pay by check Free
Pay $30 new student registration by check

Current Student Free

Total $ 0.00
Student's Name *

First Name Last Name
Birth Date *

Month Day Year
Grade
Gender *

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent/Guardian Information
Name *

First Name Last Name
Cell Number *

Area Code Phone Number
E-mail *
Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Alt. Phone Number

Area Code Phone Number
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
I would like to attend the Thanksgiving holiday camp?

Yes No
Should be Empty:

September 6th-December 18th (14 weeks)