Apple Tree Farm - 2025 Fall Tiny Trotter Sessions

Apple Tree Farm - 2025 Fall Tiny Trotter Sessions

November 10, 17, 24, and Dec. 1 3:30-4:30
Tiny Trotter
Young Rider Week
Advanced Program
Only for riders completing at 3-phase competitions.
Rider Name*

First NameLast Name
Rider Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Mother's Name

First NameLast Name
Mother's Cell Phone

Area CodePhone Number
E-mail
Mother's Work Phone

Area CodePhone Number
Father's Name

First NameLast Name
Father's Cell Phone

Area CodePhone Number
Father's Work Phone

Area CodePhone Number
Physician's Name

First NameLast Name
Physician's Phone

Area CodePhone Number
Insurance Company
Group#/Policy #
Emergency Contact

First NameLast Name
Emergency Phone #

Area CodePhone Number
Does the rider have any medical conditions or learning disabilities we should know about? Please explain
Please list any medications the rider is taking.
Briefly describe riding experience
Parent Signature*

Clear
Fall Sessions *
prevnext( X )
Fall Sessions$395.00

Total $0.00
Should be Empty: