Holiquin Application


Holiquin Registration - Group Riding Lessons

*Note* Please print out this application - fill in the required information and bring it along or mail it to Holiquin.

*A $25.00 non-refundable deposit required with application.  Deposit to be deducted from balance of lesson fee.

STUDENT'S NAME: _________________________________________________

BIRTH DATE: _____AGE____HEIGHT_____WEIGHT_____(needed to match horse & rider)

ADDRESS:__________________________________________________________

CITY/STATE/ZIP CODE_______________________________________________

PHONE: (home)_____________________ (work)___________________________

PARENTS NAME:____________________________________________________

EMAIL ADDRESS: ___________________________________________________


RIDING OPTIONS:
_____WEEKLY LESSONS
_____TWICE WEEKLY LESSONS
_____THRICE WEEKLY LESSONS

DAY AND TIME OF LESSON:(1)____________(2)____________(3)_____________

RIDING LESSON BACKGROUND, INCLUDING PLACE OF INSTRUCTION:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

RELEASE OF LIABILITY: This rider has my consent to participate in Holiquin Riding Center's Lesson Program. I release and agree to indemnify Holiquin Riding Center and its staff from any and all liabilities incident to the rider's participation in this program.

______________________________________ Date:________________________
Parent/Guardian Signature


*Return registration and deposit to insure availability.