REGISTRATION FORM
Student Name, Age, Date of Birth:
Address:
Guardian Name and Contact Details:
Emergency Contact:
Health Card Info:
Medical History/Special Needs:
Allergies (food, medicines, insect bites etc.)
Epipen?
Standard Immunizations
Is Medication currently being taken? (Name Dose etc.)
Describe conditions, treatments currently required:
Please list/describe past medical conditions:
Other Background:
Details of Experience/Rider Level:
OEF #:
Pony Club/EC Rider Level:
How referred/found us?