Homeschool Class Registration

Parent/Guardian Information

Full Name

Address

Phone

Emergency contact name & number if different than above.

Student Information

Please list the name, gender, and birthdate of each child attending.

If there are any allergies please list the name of the student and the allergy here.

If there are any medical conditions we should know about please list the name of the student and the condition here.

Does your family have any experience with horses?

Is there anything else we should know about your child(ren)?

Do you authorize Peaceful Pastures to use and reproduce any and all photographs and adiovisual material taken of the participant and family members while in individual and/or group sessions for use in the promotion of Peaceful Pastures.

Signature

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Date

Month

Day

Year

Homeschool Class Registration

Parent/Guardian Information

Student Information

Details