Churchill Stables
Summer Riding Program Registration
Child’s name_______________________________________________________________
Last First
Date of birth____________ Age__________ current grade ___________
Approximate height and weight (to ensure we have the appropriate size horse )
Height___________________ Weight______________________________
Child’s address:________________________________________________
_____________________________________________________________
Home phone______________________
Primary Guardian Name:
Address:
Email:
Cell:_________________________ Home/Work:__________________
Guardian 2 Name_______________________
Cell________________ Home/Work_____________
Does your child have an Allergy? If so please detail any treatment plan:
Are there any behaviors that we need to be aware of in order for this to be a safe and enjoyable experience for everyone?
Please initial that you have read and understand our helmet policy.
__________________I will provide an ASTM-SEI approved equestrian helmet for my child.
Please mail this form along with your $225 non-refundable, non-transferable deposit for new all students. Returning students $200 registration fee.
Checks payable to :Churchill Stables LLC
51 Dudley Road, Bedford MA 01730