Winter 2024 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 Email

Primary Contact Phone

Emergency Contact Name:

Emergency Contact Phone:

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

Therapeutic (adaptive) Riding/January & February Lessons 2024Therapeutic (adaptive) Carriage/Cart Driving/January & February Lessons 2024 HorsePower Social Hour (unmounted 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. Note choices 1,2,3, along with time. Space is limited and based on horse suitability. Note *The last lesson of the day during winter months will begin at 4:30 or 5 pm and most lessons will conclude by 5:30pm* Saturday lessons will resume in the spring session.

Monday

Tuesday

Wednesday

Thursday

Friday

Current Fall Session Students Only: I wish to keep my current day/time for the Winter Session (exception is Saturday).

YesNo, I have indicated a change above.

Next Steps:

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

Dates: January 4-February 27, 2024

You will now be directed back to the forms page. All applicants must complete the 2024 online application/waiver (this will be available after January 1, 2024). Also, please print the physician’s statement. Your physician must complete, sign, date the form and then return to LTR, Inc. via email, or by postal mail.

If you submitted a physician's statement in the last quarter of 2023, 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