Date of Birth: _____/_____/_____         Rider Weight: __________

Address: ________________________ Rider Height: __________

City: _____________________             Postal Code: _____-______

Home Phone #:: (_____) _____-________    Bus #.: (_____) _____-________

Emergency Contact
First Name: ________________________ Last Name: _________________________

Relationship: ________________________

Medical Information
Doctor’s Name: ________________________________________________

Office Phone #: (_____) _____-_________ OHIP#: __________________

Allergies: _________________________________________________

Medical Conditions: __________________________________________________

__________________________________________________________________

Medication: ________________________________________________________

1) Have you been on a horse in the last year?        Yes [ ]         No [ ]
 
2) Please list any riding you may have done, for example trail riding, formal lessons in English or Western Riding, pleasure riding, previous summer riding camps.