Pathways On Pleasure Valley Online Registration

Registration

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Welcome to Pathways On Pleasure Valley! We’re so excited to have you here. Please complete the following registration form to get started on your horseback riding journey with us!

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 - Primary Contact)

Contact #1

Primary Contact First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Secondary Contact First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

School

Allergies (Write N/A if NONE)*

Medications (Write N/A if NONE)*

Primary Doctor*

Rider's H/W (Ex. 5'7"/150 lbs)*

Special Meal Need (Ex. Vegan)

To view available options, simply click the “Select Class” button below. From there, you can browse and select the class, session, or program that works best for you. Let the adventure begin!

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

School

Allergies (Write N/A if NONE)*

Medications (Write N/A if NONE)*

Primary Doctor*

Rider's H/W (Ex. 5'7"/150 lbs)*

Special Meal Need (Ex. Vegan)

To view available options, simply click the “Select Class” button below. From there, you can browse and select the class, session, or program that works best for you. Let the adventure begin!

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

School

Allergies (Write N/A if NONE)*

Medications (Write N/A if NONE)*

Primary Doctor*

Rider's H/W (Ex. 5'7"/150 lbs)*

Special Meal Need (Ex. Vegan)

To view available options, simply click the “Select Class” button below. From there, you can browse and select the class, session, or program that works best for you. Let the adventure begin!

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

School

Allergies (Write N/A if NONE)*

Medications (Write N/A if NONE)*

Primary Doctor*

Rider's H/W (Ex. 5'7"/150 lbs)*

Special Meal Need (Ex. Vegan)

To view available options, simply click the “Select Class” button below. From there, you can browse and select the class, session, or program that works best for you. Let the adventure begin!

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

School

Allergies (Write N/A if NONE)*

Medications (Write N/A if NONE)*

Primary Doctor*

Rider's H/W (Ex. 5'7"/150 lbs)*

Special Meal Need (Ex. Vegan)

To view available options, simply click the “Select Class” button below. From there, you can browse and select the class, session, or program that works best for you. Let the adventure begin!

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

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

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies

(Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

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

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Required Policies

(Show-Hide Details)