Lesson Registration

Registering For:

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Start Date

End Date

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Parent or Guardian 1 (required)

Cell Phone (required)

Parent or Guardian 2

Cell Phone 2

Address (required)

City (required)	State (required)	Zip Code (required)

Email (required)

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Emergency Contact if parent/guardian not available (required)

Relationship to Rider (required)

Emergency Contact Phone Number (required)

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Rider Name (required)

Age (required		DOB (required)


Height (required)		Weight (required)
Feet	Inches	Pounds

Grade

School

Medical Conditions, medications or other information RBRC should know about the rider

Beginner ( <10 hours )
Y

Riding Experience (required)

Add a second rider? Yes

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2nd Rider Name

Age (required		DOB (required)


Height (required)		Weight (required)
Feet	Inches	Pounds

Grade

School

Medical Conditions, medications or other information RBRC should know about rider

Beginner ( <10 hours )
Y

Riding Experience (required)

Add a third rider? Yes

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3rd Rider Name

Age (required		DOB (required)


Height (required)		Weight (required)
Feet	Inches	Pounds

Grade

School

Medical Conditions, medications or other information RBRC should know about rider

Beginner ( <10 hours )
Yes

Riding Experience (required)

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How did you hear about us?

Comments/Questions

You will receive a confirmation e-mail from Rockin' B Ranch. If you do not receive an e-mail confirming your reservation within an hour or so, please check your spam folder, as well as your 'Promotions' folder if you use GMail.