Rider Information Form
Share your riding experience, emergency contacts, and goals so we can match you with the right horses and lesson groups.
Rider Information
Rider's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
Height
*
Weight (lbs.)
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Is the rider under 18?
*
Yes
No
Parent/Guardian Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
Emergency Contact Name
*
Relationship to Rider
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Riding Experience
Previous riding experience level
*
No previous riding experience
Less than 6 months
6–12 months
1–2 years
3–5 years
5+ years
10+ years
Riding frequency in the past 12 months
*
I haven't ridden in the past year
A few times
Less than once per week
Approximately once per week
2–3 times per week
4+ times per week
Disciplines experienced in
Hunter
Jumper
Equitation
Dressage
No previous riding experience
Other
Skills you can comfortably and independently perform
Catch/lead a horse
Groom
Tack up
Mount/dismount
Walk independently
Steer independently
Posting trot
Sitting trot
Two-point
Canter
Canter in a group
Ground poles
Crossrails
Jump individual fences
Jump a full course
None yet
Jumping Experience
Has the rider jumped before?
Yes
No
Highest height comfortably jumped as part of a full course
Please Select
Ground poles
Crossrails
18"
2'
2'3"
2'6"
2'9"
3'
3'3"
3'6"+
I have jumped individual fences but not a full course
When did the rider last regularly ride/jump at this level?
Horse Show Experience
Has the rider competed in horse shows?
*
Yes
No
Types of horse shows competed in
Local/Schooling
USEF/USHJA Rated
Dressage
Eventing
Other
Most recent competition level/division
Current & Previous Riding
Currently taking riding lessons?
Yes
No
Approximate date of last riding lesson
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Currently own or lease a horse/pony?
Yes
No
What do you currently do with this horse/pony?
Riding Goals
What are you interested in?
*
Recreational riding
Weekly lessons
Riding multiple times per week
Hunter/Jumper training
Horse showing
Rated horse showing
Leasing a horse/pony
Purchasing a horse/pony
Improving confidence
Returning to riding after time off
I'm not sure yet
What would you like to accomplish over the next 6–12 months?
*
Any specific skills you'd particularly like to work on
Additional Information
Is there anything that may affect horse/rider matching or your ability to safely participate in riding activities?
*
Yes
No
Please explain any factors that may affect horse/rider matching or safe participation
How Did You Hear About Us?
How did you hear about us?
*
Current Sammon Equestrian client
Friend/Family
Google
Facebook
Instagram
Horse show
Other
Who should we thank for the referral?
Rider Information Acknowledgment
Acknowledgment
Rider Name
*
Parent/Guardian Name (if rider is under 18)
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: