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