New Student Application

New Student Application

Information on this form will be used to assess the applicant's suitability for placement in our program and must be completed prior to evaluation for placement.
Date

MonthDayYear
Date
Applicant's Name:*
Nickname:
Parent/Guardian Name:*
Full Address (street, city, zip):*
Cell Numbers:*
E-mail:*
Parents' Employer:*
How did you find out about Helping Horse?*
Student's Background
DOB:*
Age:*
Height:*
Weight:*
The weight limit for our horses is less than 200 pounds. Unmounted lessons are possibly an option for some applicants.
Applicant's Disability Diagnosis:*
Please list any limitations of the applicant:*
Method of communication:*
Previous horse experience:*
If Yes, please describe:
Applicants are assessed for removal from the waiting list as spaces in the program become available. They will only be placed into classes when the rider's level of support needed and horse availability is in line with a vacancy in the program, not necessarily based on length of time on the waiting list.
Helping Horse Therapeutic Riding Program does not and shall not discriminate on the basis of race, color, religion (creed), pregnancy, gender, gender expression, sexual orientation, national origin, age, disability, veteran/military status, marital status or any other protected characteristic in any of its activities or operations.
Should be Empty: