Ridgefield Riding Academy Online Registration

Registration

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Welcome to Ridgefield Riding Academy! Please complete the following registration form. ***POLICIES:*** It is important that you open and READ VERY CAREFULLY EVERY POLICY below by clicking the "Show/Hide Details" tab by the heading "Required Policies and Agreements". These clearly outline how our programs will run, so you are infomred! If a policy box is checked, it indicates you have read and agreed and is considered your digital signature.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Relation to student*

How Can We Contact You?

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Relation to student*

How can we contact you?

Cell # *

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor

Riding Level. W/T, xrail, etc.

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor

Riding Level. W/T, xrail, etc.

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor

Riding Level. W/T, xrail, etc.

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor

Riding Level. W/T, xrail, etc.

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor

Riding Level. W/T, xrail, etc.

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Payment Options*

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies

(Show-Hide Details)