Horse Kids Club Registration Form

Horse Kids Club Registration
Child Information
Child’s Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Participating the following days:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the child prescribed an inhaler? If yes, please explain any instructions.
Please note

QRF reserves the right to cancel or combine days based on minimum required program participation and participation maximums. Each participant can have a maximum of 2 “Make up” sessions which will be available on a handful of pre-announced weekend days per semester. Participants are not able to switch to/from weekdays without explicit permission.
Parent/Guardian Signature

First Payment

Balance due first day of program

$300.00

Total

Payment Methods

Debit or Credit Card

ACH Bank Transfer

Upon Submitting this form,

you will be redirected to a release form which is REQUIRED for all participants.
Should be Empty:

Horse Kids Club Registration