Adult Leisure Package

Welcome to Town Line Farms & Stable!

*This form is NOT a liability waiver.
This package is designed to give our adult novice/intermediate riders a regular supervised riding time for safety, without the “kids’ lesson” feeling. Access to once weekly 1-hour lessons on our horses, with our tack. $250/month.
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.
Parent/Guardian/Conservator Name

First NameLast Name

Availability for Adult Leisure Lessons *

	M	T	W	Th	F	Sa	Su
Early Morning (before 9am)
Late Morning (9am-11am)
Early Afternoon (11:30am-1:30pm)
Late Afternoon (2pm-4:30pm)
Early Evening (5pm-7pm)
Late Evening (7:30 or later)

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 acknowledge that a LIABILITY WAIVER must be completed prior to receiving services at or from Town Line Farms & Stable*

Yes
Click on the following link to complete the LIABILITY WAIVER:

(link will open in a new window)

Liability Waiver
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Adult Leisure Package SubscriptionThis package is designed to give our adult novice/intermediate riders a regular supervised riding time for safety, without the “kid lesson” feel. Access to once weekly 1-hour lessons on our horses, with our tack. Currently offered on Tuesdays and Wednesdays at 10AM weekly. May also be offered on Wednesday 5PM Evenings for 3 to 5 person groups. This is a subscription charged per month. If wishing to cancel this subscription a 30 day notice is required prior to next auto charge.
$250.00 Quantity

Total

$0.00
Email*
Receipt will be emailed - example@example.com
Should be Empty:

Welcome to Town Line Farms & Stable!