2023 New Rider Assessment Booking Form

New Rider Assessment Booking Form

Our riding assessments are 15-20min in length with the purpose of assessing the ability of the rider as well as matching the rider with the appropriate instructor and lesson horse.
Student to be assessed name *

First NameLast Name
Program student is to be assessed for*
Has student ridden in the past?*
If "Yes", please let us know the level of their experience and what type of riding they have done.
Age - Potential students must be at least 5yrs old for traditional or adaptive riding lessons.*
Height*
Weight*
Wheatland Farm has a strict weight limit of 180lbs for participants, for their safety, and for the safety of our horses and volunteers. Thank you for your understanding.
Does student have a disability?*
If "Yes", please describe disability including any adaptive devices required for daily living and mobility.
Does the student have mobility challenges that would require the use of an electric lift to mount the horse?
If you selected "yes" for the student disability question, please review the attached Contraindicatons document as well as have your physician complete the Physician Referral form. Physician referral form should be brought with you to the scheduled assessment.
Services student is currently receiving*

PTOTSpeechN/A
Does student have a Behavioral Intervention Plan (BIP) in place?*

YesNo
If Yes, please explain behaviors *
Parent Name *

First NameLast Name
Parent Email *
example@example.com
Mobile Phone Number *

Area CodePhone Number
Please let us know a few good days and times to visit for an assessment. Please note, we are closed on Sundays.
Preferred days/times for riding lessons (you may choose more than 1)

Mondays between 2p-4pMondays between 4p-7pWednesdays between 2p-4pWednesdays between 4p-7pFridays between 10a-12pFridays between 12p-2pFridays between 2p-4pFridays between 4p-7pSaturdays between 9a-12pSaturdays between 12p-3pSaturdays between 3p-6p
Which lesson option do you prefer?

30min private60min group60min private - advanced riders only
How did you hear about Wheatland Farm?
Signature*

Clear
Before an assessment can be booked, we must have the electronic liability waiver completed.

We look forward to meeting you!
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