Pony Club Registration Form

Thank you for registering for Renegade Farm's Pony Club! We look forward to having you attend and participate in the many fun and educational activities.

Please fill out the registration form. If you are under 18, please be sure to have your parent or guardian fill in and sign the form. Once the form is filled out, please be sure to print and mail it along with the $35.00 registration fee to:

Renegade Farm
5489 Mariaville Rd (Route 159)
Schenectady, NY 12306

*Full Name (First M Last):
*Date of Birth:	/ /
*Grade in School:
*Number of Years Riding:	English Western
If you have ridden at other barns, please list them:
*Address:
*City, ST Zip:	,
*Home Phone:	- -
*Emergency Contact:
*Emergency Phone:	- -
*Email:
*Sweatshirt Size:
*Parent or Guardian's Name:
Please sign after printing	____________________________
*Date:

Please print this form and either mail it to along with the $35.00 registration fee to Renegade Farm.