Beginner Horsemanship Class Enrollment Form & Questionnaire
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Date of Birth
-
Month
-
Day
Year
Date
Emergency contact
Name
Number
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Self Assessment Information
What are your goals for this class? (Check all that apply)
Build confidence around horses
Learn horse care and handling
Develop basic riding skills
Prepare for more advanced riding
Other
Have you ever ridden a horse before? ?
Yes
No
Do you have any previous horse handling experience? (Y/N) - If yes, please describe:
How long are you interested in participating in this programs?
1 Month Ago
2 Months Ago
Unsure
Other
How do you rate yourself in terms of teamwork?
1
2
3
4
5
6
7
8
9
10
Worst
Best
1 is Worst, 10 is Best
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Medical Information
Any allergic reaction to medicines (e.g. aspirin, penicillin, etc.)?
Please provide and explain.
Are you currently taking any prescribed medications?
Are you experiencing any epileptic seizures?
Please Select
Yes
No
Do you have Diabetes?
Please Select
Yes
No
Have you had any operation in the last two years?
Please Select
Yes
No
Please specify, which operation have you had?
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Disclaimer
Submit
Should be Empty: