Junior Rider Program Application

Summit Farm

D/B/A

Summit Equestrian Club

24 Bloomer Rd

North Salem, NY 10560

(914) 879-0346

info@summitequestrianclub.com
Junior Rider Program Application

Initiation Fee: $5,200 (One-Time, Non-Refundable, Non-Transferable)
Rider Name

First NameLast Name
Age
Height
Weight
Parent / Guardian Name

First NameLast Name
Parent / Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Guardian Email
example@example.com
Parent / Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Signature*

Powered by Jotform SignClear
Today's Date*

MonthDayYear
Date
Summit Equestrian Club · 24 Bloomer Rd · North Salem, NY 10560 · (914) 879-0346 · info@summitequestrianclub.com
Should be Empty: