GallopNYC prospective Hippotherapy rider form


Please use this form to express interest in Hippotherapy at GallopNYC.

If you are interested in another program, please follow this link for more information:

LINK TKTK LINK TKTK


If you are unsure, or would like more information, please contact us or call 646-233-4507

Parent Information (or Rider Information if over 18)











Rider Information



Please enter date as MM/DD/YYYY




EX: verbal/nonverbal, uncontrolled seizures, social, etc.

Ambulatory? Assistive Device?