New Rider Application Please enable JavaScript in your browser to complete this form.Rider's Name *FirstLastAge *Parent/Guardian Name(s): *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePrimary Phone *Secondary PhoneEmail *Rider's Full Date of Birth *Rider's Height *Rider's Weight *Rider's EthnicityRider's Disability *What other therapies does the Rider participate in? (please check all that apply) *Physical TherapyOccupational TherapySpeech TherapyNutritionMental HealthCounselingMassage/AccupunctureOtherNoneSpecific Goals of these TherapiesSpecific Goals of Therapeutic Riding *Psychological Functions *Aversions *Transitioning into TROT *Please give us helpful information about the rider that may help him/her adjust into the program: favorite toys, songs, games, etc. Is the parent/guardian willing to assist with riding activities as necessary? *YesNoMaybeNameSubmit