Equestrian Crossings

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					                                                                        Equestrian Crossings
                                                                                          A 501(c)(3) Non-Profit


                                                                                              P.O. Box 55
                                                                                   Coupeville, WA 98239
                                                                                         (360) 320-1573

                                                                      info@equestriancrossings.com
                                                                       www.equestriancrossings.com

                         LESSON REGISTRATION FORM
Name: _____________________________________________________________________

Address: ___________________________________________________________________

City/State ___________________________________________ Zip Code: _______________

Home: __________________ Business: ___________________ Cell: ___________________

E-mail: ________________________________________________ DOB: ________________

Employer/School: __________________________________ City: ______________________
How did you learn about this program? _____________________________________________
Participant’s Signature: __________________________________ Date: ________________

Print Name: _________________________________________________________________

Signature of Parent/Guardian (if participant is a Minor): _______________________________

Print Name: _________________________________________________________________

Relationship to Participant: ________________________________ Date: ________________
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                                   PHOTO RELEASE
Check one:           I DO …                                     I DO NOT …
Consent to/authorize the use and reproduction by EQUESTRIAN CROSSINGS of any/all
photographs and/or audio/visual/electronic materials taken of person/child for educational
activities, medical progress, promotional materials, exhibitions and/or for any use for the
benefit of the person/child or the program.
Participant’s Signature: ____________________________________ Date: ______________
Print Name: _________________________________________________________________
Signature of Parent/Guardian (if participant is a Minor): _______________________________
Print Name: _________________________________________________________________
Relationship to Participant: _________________________________ Date: _______________
Updated 02/2010        Where Dreams Meet Opportunities!                Lesson information sheet Spring 2010.pdf
INSTRUCTIONS: The following lesson times, days of the week, and location are for the EqX
Spring 2010 session from 26 April to 18 June.
                           Deadline for Spring Registration is March 26th!
Check the box next to the lesson(s) you desire.
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LANGLEY ARENA
Mondays, Wednesdays or Fridays, starting April 26th
Programs: Harness Driving
                                                                     # OF
TIME              DURATION           TYPE         INSTRUCTOR         STUDENTS COST
 TBD*            Up to 2 hours      Private      Denise Boyett      1                     $45/class
*Arranged individually with Instructor.

Mondays only starting April 26th
Programs: Sport Riding [English, Western, Adaptive], Unmounted In-Hand or Vaulting

TIME              DURATION           TYPE         INSTRUCTOR         STUDENTS COST
12:00PM          1.5 hour class     Group        Miriam Burk        4                     $30/class
2:00PM           1 hour class       Private      Miriam Burk        1                     $30/class
4:00PM           1.5 hour class     Vaulting     Miriam Burk        4                     $30/class

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GREENBANK ARENA
Thursdays, starting April 29th
Programs: Sport Riding [English, Western, Adaptive], Unmounted In-Hand or Vaulting
                                                                     # OF
TIME              DURATION           TYPE         INSTRUCTOR         STUDENTS COST
12:00PM          1.5 hour class     Group        Miriam Burk        4                     $30/class
2:00PM           1 hour class       Private      Miriam Burk        1                     $30/class
 TBD*            1 hour class       Private      Emily Brink        1                     $30/class
4:00PM           1.5 hour class     Vaulting     Miriam Burk        4                     $30/class
*Arranged individually with Instructor.
---------------------------------------------------------------------------
OAK HARBOR ARENA
Fridays, starting April 30th
Programs: Sport Riding [English, Western, Adaptive], Unmounted-In Hand or Vaulting
                                                                     # OF
TIME              DURATION           TYPE         INSTRUCTOR         STUDENTS COST
12:00PM          1.5 hour class     Group        Miriam Burk        4                     $30/class
2:00PM           1 hour class       Private      Miriam Burk        1                     $30/class
4:00PM           1.5 hour class     Vaulting     Miriam Burk        4                     $30/class


Updated 02/2010           Where Dreams Meet Opportunities!               Lesson information sheet Spring 2010.pdf
Additional fees and expenses:
1. Annual EQUESTRIAN CROSSINGS Registration/Insurance fee = $30.

2. Students must provide their own ASTM/SEI approved equestrian riding helmet and proper
   footwear (boots, vaulting shoes, etc).

3. For insurance purposes, all Vaulters need to join the American Vaulting Association. Go to
   www.americanvaulting.org to join as a Club Member of the Equestrian Crossings Vaulting
   Club and for more information about vaulting.

4. Students are responsible for special event & competition entry/class fees, performance
   outfits/costumes, transportation, lodging, meals, etc.

5. Students are encouraged to become EqX Members. Individual memberships are $30/year or
   $45/year for Family memberships.

Submit completed form to: Equestrian Crossings, Attn: Student Coordinator, P.O. Box 55,
Coupeville, WA 98239.

                             We look forward to seeing you!!!!




Updated 02/2010       Where Dreams Meet Opportunities!                  Lesson information sheet Spring 2010.pdf

				
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