| Copper Mountain Ranch Box 354 Midway, BC V0H 1M0 |
1- (250) 449-2234 |
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REGISTRATION FORM Please PRINT, FILL OUT, and MAIL to us at the address below.
Student's Name: _______________________________________________________ Parent or Legal Guardian: _______________________________________________ Address: ______________________________________________________________ City: ________________________ Prov./State: ____________________________ Postal Code/ZIP: ______________________________________________________ Phone: RES. ( ) ___________________ BUS. ( ) ____________________ Date of Birth: __________________________________________________________ Gender: (circle one) M F Height: ______________ Medical Insurance Number: _____________________________________________ Health Concerns (allergies, food restrictions, medications, etc.): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Horse Council BC Membership #: _________________________________________ or, I have liability insurance through: ______________________________________ and my # is: ____________________________________________________________ RIDING EXPERIENCE: Beginner (0-6mo.) ____ Novice _____ Advanced _____ INTEREST AREAS: Dressage ____ Jumping ____ Eventing ____ Pleasure ____ Briefly describe your riding experience, including number of years
riding, number _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ SESSION CHOICES: 1. _______________ 2. _________________ 3. _______________ List 1st, 2nd and 3rd preferences if possible. We will do our best
to accomodate you. Have a good ride!
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