Student Participant Application

Riding Instruction Participant Application

All information is intended for internal use only and will not be disclosed to anyone outside of THP.
Our private riding instruction program is provided to all children age 9 years through adult. Due to the nature of this program, scholarships are not available for private riding instruction.

*THP Programs including EAL Horsemanship 101 and Adaptive Riding are limited to children ages 5-18 years old fitting the program requirements. Please do not complete this application if your student qualifies for either of these programs.
How did you hear about our program? *

PARTICIPANT INFORMATION
Participant /Student Name: *

Preferred Name Legal First Name Last Name
Birth Date: *

Month Day Year
Height *
Weight *
Horse Use Information *

I own and will bring my horse I do not have a horse to bring
Horse Riding Experience: *

I have 5+ years riding experience I have 1+ years riding experience I have less than 6 months riding experience I have no riding experience
Horse Knowledge *

I have some horse knowledge I have little horse knowledge I have no horse knowledge

PARENT/LEGAL GUARDIAN INFORMATION
Parent/Legal Guardian:

First Name Last Name Relationship
Select One *

I am 18 years old or more and am able to sign for myself I am the legal parent/Guardian for the above student
Phone: *

Area Code Phone Number
Mailing Address: *

Street Address

Apt, Lot, Suite, etc

City State

Zip Code
E-mail: *

EMERGENCY INFORMATION
Primary Care Physician: *
Primary Care Physician Phone Number *

Area Code Phone Number
Allergies: *
Type NONE if not applicable

ALTERNATE GUARDIAN/CAREGIVER INFORMATION (optional)
Parent/Guardian or designated alternate must stay onsite with the participant at all times.
Alternate who may bring the child/participant:

First Name Last Name Relationship
Alternate's Phone Number

Area Code Phone Number

CONSENTS AND AGREEMENTS
REQUIRED *

By submitting this application, I acknowledge that I am 18 years old OR I am the legal parent/guardian and am able to sign this application for the participant listed above.
REQUIRED *

I hereby authorize THP to process this application and keep this information on file for internal use only (including registration, billing, and planning of programs for the participant listed above)
REQUIRED *

I hereby authorize THP to collaborate with the instructor, Elaina Tonto, for the processing of this application and delivery of riding instruction services.
REQUIRED *

I understand that this application is the start of a process. I am not committed to participation if I change my mind after my consultation. I also understand that THP does not guarantee to provide services if the current program would not benefit the applicant/participant. THP is an equal opportunity program and does not discriminate.
PHOTO RELEASE: Please make a selection: *

I DO give consent for the use and reproduction of all photographs and/or other audio/visual materials including the above participant for any promotion, educational activities or training, and any other use for the benefit of The Horse Prayer organization and programs. (including but not limited to web, social media, advertisement, etc) I DO NOT give consent for any photographs, audio, or visual recordings of the participant to be used for promotional material, educational activities, exhibitions or for any other use for the benefit of The Horse Prayer organization and programs.
E-Signature Required Before Submitting Application *

By submitting this form, I attest that this my legal signature. Clear
Should be Empty:

Riding Instruction Participant Application