GallopNYC Prospective Recreational Rider Form

GallopNYC Prospective Recreational Rider Form

Please use this form to express interest in the recreational riding program at GallopNYC.

Please note that not all days/times or locations are available at any given time.

Parent Information (or Rider Information if the rider is an adult)

Title

First Name

Last Name

Address:

Street

City

State

Zip Code

Phone (mobile preferred)

Email

Are you signing up for recreational riding for yourself or for someone else?

Rider Information

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Please enter date as MM/DD/YYYY

Height (x'y" format)

Weight (lb)

Are you a U.S. Armed Forces Veteran?

YesNo

Preferred Location (Check all that apply)

Brooklyn - Bowling Green at Prospect ParkQueens - Sunrise Stables (Lindenwood)Staten Island - Ocean BreezeBronx - Riverdale Stables

Preferred Day/Time (Check all that apply)

Monday AMMonday PMTuesday AMTuesday PMWednesday AMWednesday PMThursday AMThursday PMFriday AMFriday PMSaturday AMSaturday PMSunday AMSunday PM

Ethnic Background

Please List any Additional Riders

First + Last Name

Any other Comments, Questions, or Concerns

Please add any information you would like to share with us

Contact Information