StirrUp Purpose Sport Riding Application

StirrUp Purpose

at Faith Run Farms

60575 Billadeau Rd, Bend OR 97702

541-410-0164
Sport Riding Student Application

Please let us know a little about you!
Participant Name

First NameLast Name
MinorIndependent AdultAdult with Legal guardian
If the Participant is a minor or an adult with a legal guardian, please complete the following information for the participant. If the participant does not have phone or email, please enter parent or legal guardian contact information.
Parent/Guardian Name

First NameLast Name
Participant Date of Birth*

DayMonthYear
Participant Age*
Participant Gender*
Participant Phone Number*
Format: (000) 000-0000.
YesNo
Participant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant Email*
example@example.com
Participant Height (ft.inches)*
Participant Weight (lbs)*
Participant School/Institution/Employer:*
VeteranActive MilitaryFirst ResponderNone of the above
NoneOne time pony, sleigh or trail rideSome riding lessons/beginnerIntermediate riderAdvanced/Experienced riderOther
Tell us about any physical, cognitive or behavioral health issues or concerns that we should be aware of while working with the Student:
Tell us about your goals for participating?*
Monday morningMonday afternoonMonday eveningTuesday morningTuesday afternoonTuesday eveningWednesday morningWednesday afternoonWednesday eveningThursday morningThursday afternoonThursday eveningFriday morningFriday afternoonSaturday morningSaturday afternoonSunday afternoon
I do hereby attest that this information is true, accurate and complete to the best of my knowledge.
Current or past participantWebsite/Social MediaCommunity OrganizationOther
Signature of Participant or Legal Guardian of Participant*

Clear
Signature of Participant or Legal Guardian of Participant (typed name indicates signature):*
Date*

MonthDayYear
Date
Email
example@example.com
Should be Empty:

Sport Riding Student Application