Winter 2023 Lesson Request

General Information

Participant's First Name

Participant's Last Name

Participant's Birthdate (use MM/DD/YYYY format)

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/January/February Lessons 2023Therapeutic Carriage/Cart Driving/January/February Lessons 2023 Equine Assisted Learning (unmounted horsemanship activities - Horsepowered Learning)

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. Note choices 1,2,3, along with time, and Space is limited and based on horse suitability. Note *The last lesson of the day during winter months will begin at 4:00 or 4:30 pm and most lessons will conclude by 5pm*

Mon

Tues

Weds

Thurs

Fri - limited hrs

Sat AM schedule is currently full**

Fall sessions participants only - I wish to keep my current day/time:

YesNo, I have indicated a new preference above.

Next Steps - Please read!

Thank you for completing the lesson registration request form. Space is limited.

Dates: January 9 -February 25, 2023

You will now be directed back to the forms page. All applicants must complete the 2023 online application/waiver (this will be available after January 1, 2023).

Also, please print the physician’s statement from the website. Your physician must complete, sign, date the form and then you may return it to LTR, Inc. via email, or by postal mail.

If you submitted a physician's statement in the last quarter of 2022, this form may not be required for winter lessons.

The LTR Program Director will contact you with a final schedule. Invoices for program service fees will be sent by email at the end of each month of winter lessons (January & February) and offered weather permitting.

Contact Information