REGISTRATION FORM for Orientation Class

NAME (last) ____________________(first)______________________BIRTHDAY_________

ADDRESS_____________________________CITY___________________ZIP___________

PARENT OR LEGAL GUARDIAN________________________________________________

HOME PHONE #_____________________WORK PHONE #_________________________

EMAIL______________________________________________________________________

EMERGENCY CONTACT__________________________PHONE #____________________

NAME OF PERSON(S) ALLOWED TO PICK-UP CHILD:

____________________________________DRIVERS LICENSE #_____________________

Below, please choose a date for your 1st choice and 2nd choice of the Orientation Class you
would like to attend. In the event your 1st choice is full, we will place you in your 2nd choice.
Use the online session schedule to determine the orientation dates.

Orientation Session Fee is $40 per session. Payment must be received in full to ensure reservation.	_________________ 1st Choice Session Desired Class Time:_________	_________________ 2nd Choice Session Desired Class Time:_________
Amount Enclosed:____________	Check Money Order Credit Card
Signature: _____________________________________Date:______________

If paying by Credit Card select one: Visa MasterCard Discovery American Express

Name:____________________________ Card # __________________________ExDate:_____

Amount to be Charged: $_________ Signature:_______________________________________

Mail form, signed waiver and tuition payment (check or money order made out to Capricorn Equestrian) to: Capricorn Equestrian, 6101 Ben Road, Sachse, Tx 75048.

© 2010 Capricorn Equestrian Center
6101 Ben Road
Sachse, TX 75048
(972) 530-1124
Chad Easterling, Owner
(972) 839-2721
Email