Name *

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Prefer to be Called:

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Date of Birth *

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Address *

Address 1

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Phone *

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Are you a current lesson program participant? *

(Lesson program participation is not required to become a club member if over the age of 18!)

I AM a curent lesson student

I am a previous lesson student NOT currently taking lessons

I am NOT a current lesson student

Are you or an immediate family member (parent, spouse) a Dakota Stables boarder? *

I AM a Dakota Stables boarder

I AM NOT a Dakota Stables boarder

Name

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Address (if different)

Address 1

Address 2

City

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Phone

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Name of Emergency Contact #1 *

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Phone of Emergency Contact #1 *

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Name of Emergency Contact #2

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Phone of Emergency Contact #2

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Name of Emergency Contact #3

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What topics are you most interested in learning about? *

(Check all that apply)

Mindfulness & Presence

Noticing Energy

Noticing Stages of Tension

Understanding Expectations

Polyvagal Theory

Following a Horse's Lead

Energy Transfer with Horses

Developing Partnership

EVERYTHING!