Equestrian After School Registration Form

Equestrian After School Registration Form
Rider Information
Rider's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
School's Name To Be Pick Up
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
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.
My Products
prevnext( X )
1st Semestre registration Once a Week
$1,100.00



Semester Payments Per MonthPlease Select the Correct Month For Payment
$206.25 Month of the Semester



1st SemestreTwice Per week
$1,800.00



Semester Payment Per MonthPlease Select the Month
$337.50 Month of the Semester



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Rider Information