Darby Downs Academy Registration

Participant’s Name:                      Male          Female

Parent’s Name (if participant is under 18 years of age): 

Address:          

Participant Age            E-mail of Participant or Parent: 

Home Phone:               Cell Phone:      

Semester Requested:    Semester 1 - March 6 March 20 April 10 April 17 Semester 2

Class(es) Requested (if not attending full semester):       Class 1 - March 6th Class 2 - March 20th Class 3 - April 10th Class 4 - April 17th No Class - Signed Up for Semester

Riding Experience (do not fill out if in Darby Downs Lesson Program): 

Please indicate any medical conditions that Darby Downs and the Instructor should be aware of: 

Check with your physician before beginning any exercise program. 

 Payments may be made by Paypal or Credit Card through the Paypal link on  the Academy Page of the Web Site.  If mailing a check, please make check payable to Darby Downs Equestrian Center  $60 Semester or $25 Per Class/Session.  Payment should be mailed to:  Darby Downs Equestrian Center, 1000 Tray Road, Irwin PA  15642

Paying on Line        Mailing Check    Check #                                         

I found out about this program through: 

Web Site                  Newspaper Article                 Friend Referred Me            E-mail                        Advertising Flier                    Other (Please Explain)

 This is only a registration form.  A Waiver of Liability/Release form must be completed upon arrival at Darby Downs Equestrian Center to participate in this program.  Waiver must be signed by parent(s) if participant under 18 years of age.