| DAKOTA RIDGE STABLES 15001 Fischer Avenue, Hastings Mn. 55033 / 651-437-8683 |
| PRIVATE LESSON REGISTRATION |
| Name ______________________________________________________________________AGE__________ Parent or Guardian__________________________________________________________________________ Address____________________________________________________________________________________ Home Phone________________________________________Cell_____________________________________ |
| EMERGENCY INFORMATION |
| Emergency Contact (Name and Phone Number) _____________________________________________________________________ |
| HEALTH INSURANCE INFORMATION Ins. Company___________________________________________________________ Policy Number__________________________________________________________ Policy Holder Name______________________________________________________ |
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| All students must have Health Insurance Coverage |
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