Student Name *

First Name

Last Name

Parent/ Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Student Date of Birth *

MM

DD

YYYY

Preferred Day(s) For Lessons *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Preferred Time For Lessons *

During the Day

After School

Evening

Lesson Consistency *

Weekly Lessons

Bi-Weely Lessons

Once a Month Lessons

Student Experience *

None- I may have had a pony ride but never steered independently

Beginner- I have ridden before & know how to steer independently

Intermediate- I can steer independently & working on posting and/or gaiting

Advanced- I can steer independently, I know the correct diagonals, I can trot/ gait & cantered, I can catch/ groom/ tack my horse independently

Preferred Lesson Option *

1/2 Hour Private

1 Hour Private

1 Hour Semi-Private

1 Hour Group

I am interested in carting lessons *

Yes

No