New Client Registration

  • Trotting Horse Therapeutic Riding (THTR)


    New Client Registration

  •            20

  • Format: (000) 000-0000.

  • Emergency Information - Required

    Please furnish the name and phone number of a contact person (if under 18, in addition to a parent)

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Minors / Clients with Guardians

  • Legal Guardian 1 (Ex: Jane Doe, Mom)

  • Format: (000) 000-0000.

  • Legal Guardian 2 

  • Format: (000) 000-0000.

  • Medicaid

    NOTE: THTR is covered under Montana Medicaid Community & Home Based Services. In order for our services to be covered by Medicaid, clients are required to be enrolled in a participating Medicaid Waiver program and have a caseworker with the ability to provide a Prior Authorization Referral for services. ANY and ALL charges not covered by Medicaid will be billed and due by the client or guardian.

  • Format: (000) 000-0000.

  • Client Information - Fill out all that apply

  • 3. WHEELCHAIR?          Notes:

  • 6. COMMUNICATION STYLE?   
                       
       

  • It is the responsibility of the participants, parents and guardians to notify Trotting Horse Therapeutic Riding if any of the above information changes during the year the application is in effect.

    Trotting Horse Therapeutic Riding is a 501(c3) nonprofit organization dedicated to providing therapy riding to Montanans in need. All donations are deductible to the fullest extent of the law.

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