NEW RIDER APPLICATION FORM FOR 2018 RIDING SEASON

Lanark County Therapeutic Riding Program
30 Bennett Street, Carleton Place, ON K7C 4J9
613-257-7121, x3236
Fax 613-257-2675 www.therapeuticriding.ca

 

 

New Rider Application Form 2018

After you have completed and submitted this application form, we will be in touch with you in order to arrange an in-person visit to meet the new applicant, to discuss their participation in the riding program and to answer any questions you may have. Thank you for your interest.
Date:  
Name of Rider:  
Date of Birth:  
Height:  
Weight:  
Disability & description of how they are affected:  
What do you hope to gain from the riding:  
Name of parent/guardian:  
Address: (St., City)  
Postal Code:  
Home Phone:  
Work Phone:  
Email:  
Emergency contact name:  
Relation:  
Emergency phone:  
 

Lessons take Place:

Spring (May-June), Summer (July-August) and Fall (September-October) at two locations: 

Smiths Falls Location: Corner Stone Stables, Port Elmsley
Beckwith Location: Ashland Farm

Referral by:  
I would like to ride in:    Smiths Falls       Beckwith   
I would like to ride in:      Spring       Summer       Fall   
The best day and time for lessons:
          

 

 

 
 

 

 

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