Rider Information Form

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Name *

First

Last

Email *

Phone Number:

Age

Selected Value: 0

Address

Previous Riding Experience

Dates Requested

Emergency Contact #1

Name and phone number

Emergency Contact #2

Name and phone number

Health Information

OHIP Number and version code if possible. Health conditions, previous injuries, allergies or illness the staff should be aware of.

E-transfer to luckoftheirish.splash@gmail.com *

I agree that a non refundable deposit of $75.00 must be received to reserve your spot