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

 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 allisonacres@yahoo.com.  Thank you!