Please print, fill out, and mail to Cindi Scoleri, 13512 Alta Mesa Road,
Galt, CA, 95632.  Or print, fill out, scan and email to

 If you have questions, call (209) 224-4304

Child's Name  


Child's Age and Grade Entering  


Parent(s) Name(s)  


Street Address  


City, Zip  


Home Phone  


Cell Phone  


Work Phone  


Emergency Contact Name and Phone  


Does your child have any riding experience?  If so, please describe:



Does your child have any difficulties with academics?  If so, please describe:



Which session(s) do you want your child to attend?



Please include a $150 deposit with this form, with check made out to Cindi Scoleri, or pay by PayPal to  Thank you!