Heroes on Horseback

CONTINUING REGISTRATION FORM

SUMMER SESSION 2008 – 6 weeks
June 16th through July 23rd

Please sign below to indicated your plan to participate in the Six Week Summer 2008
session. Please indicate any information that has changed since the last registration.
Session Fee is $150. Please contact the office if payment arrangements are needed.
Your instructor will be in touch with you to confirm the lesson time.

Participant Name: __________________________________________________

Lesson DAY OF WEEK:______________________

Indicate changes below:

E-Mail Address: Home Phone: Mobile Phone:

Address: City: State / Zip:

Emergency Contact:: Phone: Phone:

Medical Conditions & Medications:

Other :

□ To my knowledge there are no known changes to the participant’s medical conditions,

medications or contact information.

Please reserve my space in the Six Week Summer 2008 Session June 16th – July 23rd
SIGNATURE/ DATE: