*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.
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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: ___________________________________________________
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:________________________
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