Address: 4305 Hamilton Rd. Lakeland, FL 33811 Phone:(813)230-9805

Please read and fill out completely, signing the bottom of the last page where indicated acknowledging that you have read, understand and agree to all terms contained herein.

Student Name*

Primary Diagnosis*

Age*

Birthday*

Gender

Many times our Equine Therapy Services are offered in an extension of additional therapy services provided by another therapist. So that we may design a riding program best to accommodate your family, please share any specific short or long term goals from a physical, occupational, or speech therapy plan that may be helpful for us to know.

Please share any helpful hints that might support our success when it comes to working specifically with your child. ie. strong likes or dislikes, favorite things, tendencies, approaches that tend to work well, etc*

Primary Contact Name*

Address*

Primary Phone*

Primary Email*

example@example.com

Secondary Contact Name

Phone

Email

example@example.com

All Payments are due, in full, at time of Equine Assisted Therapy.

How would you like to pay?

Safety Gear

I understand that a proper riding helmet and boots are necessary safety equipment for any equine activity and I take full responsibility for providing and for the wearing of such equipment while my child is SO engaged in equine activities.

April's Acres

Riding Session Terms and Policies

Most Equine Assisted Therapy Sessions will average half an hour in length. However, each individual Equine Assisted Therapy session is objective based, not time based and the actual length of instruction may vary depending on the student's progress that particular day.
Your appointed day and time are when your Equine Assisted Therapy sessions have been scheduled for. This is the block of time you are paying for and the block of time we have set aside for your child's Equine Assisted Therapy. If you are late for the appointed time, that time may be taken out of your session. For example, if your session is at 10:00 AM and you arrive at 10:20, the ending time for your session is still 10:30 and your available session may be reduced accordingly.
Payments are due, in full, on the day of each Equine Assisted Therapy session. There are NO REFUNDS ON ANY PREPAID sessions.
All cancellations require 24 hours notice. If you do not provide 24 hours notice for a cancellation, your session will be forfeited and a cancellation charge of $25.00 may be due. With 24 hours notice we will do everything we can to reschedule but it is subject to availability.
Our primary goal is that the student be able to participate in horse activities as safely as possible taking into consideration that such activities horses are inherently dangerous. Next is that they enjoy the activity and finally, that they learn the necessary skills to accomplish their individual and personal goals.

Date of Request*

Date

Parent Signature*

Registration Form

All Payments are due, in full, at time of Equine Assisted Therapy.

Safety Gear

April's Acres

Riding Session Terms and Policies