Name *

First Name

Last Name

Prefer to be Called:

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you a current lesson program participant? *

(Lesson program participation is not required to become a club member!)

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 *

First Name

Last Name

Address (if different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Name of Emergency Contact #1 *

First Name

Last Name

Phone of Emergency Contact #1 *

(###)

###

####

Name of Emergency Contact #2

First Name

Last Name

Phone of Emergency Contact #2

(###)

###

####

Name of Emergency Contact #3

First Name

Last Name

Phone of Emergency Contact #3

(###)

###

####

What topics are you most interested in learning about? *

(Check all that apply)

Horse Care

Parts of the Horse

Horse Behavior / Herd Activity

Safety Around Horses

Jobs with Horses

Things Horses Can Do

Tack & Barn Equipment

Riding Disciplines

EVERYTHING!