Glencroft Farm

Southampton, Massachusetts

RIDER'S NAME
ADDRESS:
PHONE
EMAIL
RIDER'S AGE:
- Under 18
- Over 18
PARENT/GUARDIAN (if rider under 18): Please type "n/a" if this does not apply to you
DIVISION ("juniors" ride in one of these):
- Novice has basic walk/trot skills. Obstacle has simple challenge(s).
- Intermediate has basic walk/trot/canter skills. No lead requirement. Slightly more complex challenges at most obstacles.
- Advanced has experience in walk/trot/canter, patterns with designated leads. Complex challenges at each obstacle to show skills.
Horse's Name:
Horse's Age:
Horse's Breed:
Horse's Gender
Horse's Color:
Owner of Horse (Please type "Same" if not different from rider)):
Emergency Contact Name:
Emergency Contact Phone Number:
I have read and signed the Glencroft Waiver and Release of Liability:
- Yes
I have read the Glencroft Rules and Regulations:
- Yes
RIDER SIGNATURE:
PARENT/GUARDIAN SIGNATURE, IF RIDER UNDER 18: (Please type N/A if this does not apply to you.)
Payment options
If you are paying online; I have submitted payment via Paypal "Buy Now' button. Button is above and to the left:
- Yes
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