Student Fact Sheet for New Riders

Welcome to Town Line Equestrian School!

*This form is NOT a liability waiver. A link to the liability is at the end of the form.
www.townlinefarms.org

6556 Morris Thomas Road• Cloquet, MN 55720
Best Contact Email
example@example.com
Please complete and submit this form to request more information from Town Line Farms regarding beginner lessons!

A representative will be in contact soon!
Rider's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary/Parent Phone Number*
Please enter a valid phone number.
Rider/Alternate Phone Number
Please enter a valid phone number.

Availability for Lessons *

Parent/Guardian/Conservator Name

First NameLast Name
Medical History (Please mark all of the following that apply to this rider)

NoneContacts/GlassesHard of Hearing/DeafRecent Head, Back, or Neck InjurySeizure DisorderAsthmaExisting Heart ConditionsDiabetesDiarrhea, Constipation, or GI issuesSkin ConditionsJoint Problems (recent or chronic)Previous Hospitalizations/SurgeriesChronic or Recurring Illness (not previously listed)Emotional, Social, Learning, or other Mental Health Concerns (ADHD, Anxiety, Depression...)Sleep Issues (Insomnia, Night Terrors, Bedwetting...)Activity RestrictionsOther Concerns not previously listedAllergies (non-life threatening)Severe/Life Threatening FOOD AllergiesOther Severe/Life Threatening Allergies
If you checked any of the above boxes, please explain here.
I understand that a liability waiver must be on file for the rider as well as visitors to Town Line Farms. Please follow this link to complete: https://form.jotform.com/222645486238059*

Yes
Should be Empty:

Welcome to Town Line Equestrian School!