Summer 2022 Lesson Registration Request

General Information for Summer Session June 20-August 29, 2022

Participant's First Name

Participant's Last Name

Participant's Birthdate (MM/DD/YYYY)

Parent/Guardian Name:

Primary Contact Phone

Primary Contact Email

Emergency Contact Name:

Emergency Contact Phone:

Please indicate the program(s) for which you are registering:

Therapeutic Riding Therapeutic Carriage/Cart Driving Equine Assisted Learning (unmounted horsemanship activities)Equine Services for Heroes (Veterans)

Please describe any changes to health or behaviors.

General attitude/Behaviors (fears, areas of concern)

Goals (i.e. What would you like to achieve? Physical improvement, leisure activity, riding skills, behavioral changes) Please be specific.

Participant Availability: Please indicate time and day preferences OR let us know in the space below that you want to keep your current spring session lesson day/time*. Note choices #1, #2, #3, along with time. Space is limited, based on horse suitability and available center resources.

Monday

Tuesday

Weds

Thursday

Friday

Saturday-limited hours

*Spring semester students: I want to keep my current lesson day/time for summer session.

YesNo, I have indicated a change request above.

Next Steps:

Thank you for completing the lesson request form.

*Please note the session ends the week LCPS start the school year. School begins Thursday, August 25, 2022*

All participants must complete the 2022 online application/waivers and submit a hard copy of the physician’s statement. Your physician must complete, sign, date the form, then you may return to LTR, Inc. via email, or by postal mail.

Spring semester students do not need to resubmit the application but must have a current physician's statement on file.

The LTR Program Director will contact you with a final schedule once space is confirmed. Invoices for program service fees will be sent by email.

Contact Information