Activity Form

Family Name/Group Name:

Your First and Last Name:

Your Email Address (required):

Age:

Weight:

Male or Female?:

Height:

Horseback Riding

How many years have you been riding a horse?

Where/When was your last riding experience? Please tell us about your riding style preferences. And finally, please tell us about any concerns you may have with riding a horse.

Please tell us the kinds of horseback riding you may have interest in:

 Advanced Horseback Riding

 All Day Ride

 Scenic Riding

Medical History.

Please check those items that apply:

 Heart Condition

 Convulsions

 Circulatory Problems

 Muscle & Joint Pains

 Hemophilia

 diabetes

 cancer

 High or Low Blood Pressure

 Infectious Disease

 Osteoprosis

 Arthritis

 Headaches

 Respiratory Problems

 Phlebitis

 Current Broken bones/ Sprains

 Skin Problems

Do you have any other medical situations that we should know about?

Are you allergic to bees? If so, please tell us about your allergy:

Do you have any other allergies? If so, please tell us about your allergy:

Do you have any food dislikes? If so, please try to be as specific as possible and include any allergy information, too:

If you will be under the care of any medical doctor, chiropratic, or therapist, please explain:

Will you have taken any medications in the last 6 months on your arrival date? And, are there any other items that we should be aware of while you are at the ranch or doing guided activities: