FLATWOODS FARM Equine First Aid Registration Form

EquiHealth First Aid Registration Form--FLATWOODS FARM

Please complete all fields in the registration form. You will receive a confirmation email with class details, and payment instructions if you choose to skip PayPal. Classes must be pre-paid and paid in full to ensure the proper amount of class materials and meals (if applicable). Funds are transferable but not refundable. This form needs to be completed for EACH participant. If you need assistance completing this form please call or text Jackie at 321-213-4784. Thank you.
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student E-mail
Mobile Number

Area CodePhone Number
Phone Number

Area CodePhone Number
Equine First Aid Course Presentation:
Please provide any other courses you may be interested in. A list of Equine First Aid and Emergency Planning courses available on www.equi-firstaidusa.com
Instructor will contact you directly when the next course is being offered
Please indicate if you have any food allergies: blanksblank
PAYMENT: *NEW* We are now a direct provider for STEP UP. If you wish to pay for a class with your STEP UP funds, submit the form without payment, and pay directly in the EMA. We can be found in the EMA under JLO Equine Services (Flatwoods Farm).

If the PayPal option below appears disabled OR if you prefer to use a different payment method (Zelle, Venmo, Cash, Check), submit your registration without payment and I will follow up with an email to include alternative payment options. Any questions, call or text Jackie 321-213-4784.
Registration payment. Must be selected if you wish to pay by debit/credit card.
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Single Participant ONE Fundamentals class$100.00
Select if you plan to pay by credit card or PayPal. If you plan to pay by mailing cash or a check, or electronically by Zelle or Venmo, submit the application without selecting the registration fee and follow the instructions in the follow-up email.

Total $0.00

EquiHealth First Aid Registration Form--FLATWOODS FARM

Registration payment. Must be selected if you wish to pay by debit/credit card.