Rider's Name
Address City/State/Zip
E-mail Home Phone #
Cell Phone # Work Phone #
Parent/Guard.
(minors)
Phone #
(of parent/guard.)
Emergency Contact Relationship
Emergency #
Age Group 5-7   8-10   11-13   14-17   Adult
College Student? Yes  No College Faculty? Yes      No
Riding Style   English, Western or Not Sure?
Term Autumn Term 1   Autumn Term 2   Spring Term 1   Spring Term 2   Summer

I am enrolled in:
(select one)

1161.01 Western 1     1161.02 Western 2     1161.03 Western 3
1161.05 Hunt Seat 1       1161.06 Hunt Seat 2       1161.07 Hunt Seat 3
Please tell us about your riding experience and what your goals may be, if any.
Do you require carpooling assistance from campus?Yes   No
Are you available to provide transportation from campus to this class for other students in order to share gas expenses?
Yes   No
If yes, may we provide your telephone number to potential studentís who require transportation? Yes   No
Are you taking the class for credit?Yes   No
If you plan to ride with a friend, please list the names of those individuals:
Please check ALL of the times that you would potentially be available to ride and participate in this class. The instructor will notify you of your lab time the week before classes begin which will be at the same time and day weekly for the duration of the term. Classes are organized based upon demand, so it is very critical that you list all of your availability.
Monday      8:00AM 9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM9:00PM
Tuesday      8:00AM 9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM9:00PM
Wednesday 8:00AM 9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM9:00PM
Thursday    8:00AM 9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM9:00PM
Friday            8:00AM 9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM
Do you have any additional Questions or Comments?
By clicking "Submit Query" I acknowledge that I have read and agree to the terms provided in the course information page which precedes this registration form. These terms include but are not limited to the Drop, Refund and Attendance Policies which apply to all students registering for a 1161 course.