LOGOBsmall.jpg (24390 bytes)                                 PENZANCE ACADEMY of HORSEMANSHIP
                                                                                    REGISTRATION FORM
                                                                         (for Online Registration, go HERE)

NAME:                                                                                                                                             DATE:
ADDRESS:

 
TELEPHONE:                                                                                                              E-MAIL ADDRESS:                     
AGE: (if under 18 years old)                                           PARENTS NAME:
PARENTS ADDRESS:

 
PARENTS TELEPHONE:      (HOME)                                                                                 (WORK)                                                               
EMERGENCY CONTACT:                                                                                                  RELATIONSHIP TO YOU:
EMERGENCY TELEPHONE:
DOCTOR'S NAME:
DOCTOR'S TELEPHONE:                                                                                     INSURANCE NAME:
INSURANCE  GROUP NO:                                                                                    POLICY NO:                
LEVEL OF EXPERIENCE WITH HORSES:

 

Please indicate below the program for which you are registering: 

[  ] HORSE SCIENCE FOR THE HOMESCHOOLER         INDICATE 1ST DATE PREFERENCE:                                     2ND DATE:      

[   ]  EQUINE PSYCHOLOGY & BEHAVIOR                          INDICATE 1ST DATE PREFERENCE:                                     2ND DATE:

[   ]  HORSE CARE & MGT. I                                                 INDICATE 1ST DATE PREFERENCE:                                     2ND DATE:

[   ]  HORSEMANSHIP FOR THE OLDER ADULT               INDICATE 1ST DATE PREFERENCE:                                     2ND DATE:

[   ]  CLICKER TRAINING WORKSHOP                                 INDICATE 1ST DATE PREFERENCE:                                     2ND DATE:

[   ]  HORSEMANSHIP WORKSHOP                                     INDICATE 1ST DATE PREFERENCE:                                     2ND DATE:

[   ]  ADULT CHRISTIAN HORSELOVER'S CAMP               INDICATE 1ST DATE PREFERENCE:                                     2ND DATE:

[   ]  CHRISTIAN HORSELOVER'S CAMP                            INDICATE 1ST DATE PREFERENCE:                                     2ND DATE:

[   ]  EQUINE MANAGEMENT STUDENT                             INDICATE 1ST DATE PREFERENCE:                                     2ND DATE:

[   ]  RIDING INSTRUCTION                                 LEVEL:                                 PRIVATE/SEMI PRIVATE                            DATE BEGIN:

[   ]  TRAINING        (Please call PENZANCE to speak with trainer personally.)     [   ]   WINTER EQUINE EXPERIENCE 2/18 - 2/22
                                                                                                                                [    ]   WINTER EQUINE EXPERIENCE 2/25 - 3/1

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Please make checks payable to: PENZANCE, 200 South Street, Douglas, MA 01516  (508) 476-1317.  All NEW STUDENTS must pay a $35 annual registration fee. Be sure to add this to the total of the courses/camps/workshops for which you are registering.

All students must be appropriately dressed for riding including; long pants, boots, and approved HELMET. (Adults may waiver helmet, however PENZANCE strongly recommends wearing a helmet while mounted.)  Students must bring their own drinks, lunch and snacks. Sunscreen is adviseable during hot summer months. Swimsuits, towels, shorts, sneakers are approved for any non-equine activity. Notebook, pen or pencil required for courses. Equine Management students must supply their own grooming kit and lead ropes. Treats are acceptable for the horses only with prior permission. Each student must read the "Rules and Regulations" and sign a RELEASE OF LIABILITY form prior to admittance to PENZANCE. If student is a minor BOTH student and parent must read and sign the Release. Anyone bringing his or her own horse to PENZANCE must show proof of a NEGATIVE COGGINS prior to being admitted to PENZANCE. Confirmation of registration will be sent to enrolled student or a confirming phone call will be received by the student. All classes will be held regardless of inclement   weather unless said forecast suggests dangerous conditions. Missed assignments or classes must be made up prior to receiving certificate and will be arranged with instructor.

Extended hours may be arranged with Director by contacting (508) 476-1317. In some cases, residential students may be admitted with prior arrangement and at added fees. Please inquire.

Any personal physical or emotional health issues should be brought to Director's attention prior to admission. Please make note on Registration form and you will be contacted.

Questions or concerns may be addressed to PENZANCE (508) 476-1317. 

Thank you!