2025 FALL SESSION REGISTRATION
Participant Name
First Name
Last Name
Age
Birthdate
-
Month
-
Day
Year
Date
Parent or CareGiver Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Participant Diagnosis (Brief)
Equine Assisted Services
Therapeutic Horsemanship/Adaptive Riding
Equine Assisted Learning (Unmounted/Ground Work)
Equine Assisted Therapy (Occupational Therapy)
Equine Assisted Psychotherapy
Please Select ALL Times That Could Work for Participant to Come Once Weekly. Note that Occupational Therapy (OT) is 40-minute appointments 11:20-4:40PM. Therapeutic Riding is 45-minute class.
TUESDAY
THURSDAY
11:20-12:00 PM Occupational Therapy 1:1
12:00-12:40 PM Occupational Therapy 1:1
12:40-1:20 PM Occupational Therapy 1:1
1:20-2:00 PM Occupational Therapy 1:1
2:40-3:20 PM Occupational Therapy 1:1
3:20-4:00 PM Occupational Therapy 1:1
4:00-4:40 PM Occupational Therapy 1:1
5:30-6:15PM Therapeutic Riding Group
6:45-7:30PM Therapeutic Riding Group
For Therapeutic Riding (TR) and Equine-Assisted Learning (EAL), group classes are 45 minute classes 5:30-6:15PM and 6:45-7:30PM on all three days. There are additional riding times on Wednesday as follows. Select all possible dates and times that may fit your schedule.
WEDNESDAY
12:30PM Therapeutic Riding
1:45PM Therapeutic Riding
3:00-3:45 PM Therapeutic Riding
4:15-5:00 PM Therapeutic Riding
5:30-6:15 PM Therapeutic Riding Group
6:45-7:30 PM Therapeutic Riding Group
Please Write PREFERRED Day/Time to Come Once Weekly or Once BiWeekly (Riders will be grouped by age and similar skill development or 1:1 therapy. )
Please Share Participant GOALS :: Hope to Improve/Experience in 6-week Session
I understand that the $65/appointment or class payment for entire session (i.e.$455 for seven weeks) is due Aug 1, 2025. Therapy fees are in addition to the $65/hr and are payable to the therapist. If RoG cancels, a makeup time will be offered. If Participant cancels, no makeup will be offered and no reduction of fee offered. Failure to notify RoG in advance of horse prep and volunteer arrival may adversely impact future participation in light of wait list of riders that wish to participate.
*
Parent/Caregiver Signature Required
Date
-
Month
-
Day
Year
Date
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Annual Registration Fee
For Returning Participants. Complete Participant Application Forms, Medical and Physican Forms.
$
35.00
Quantity
1
2
3
4
NEW Participant Intake Evaluation (Includes Annual Registration Fee)
For New Participants Only. Complete Participant Application Forms, Medical and Physican Forms.
$
75.00
Quantity
1
2
3
4
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