Rider Application Form

This application is to ascertain the eligibility of each individual for consideration of entrance into this riding program. Please read the rider criteria carefully, as therapeutic riding is not appropriate for all individuals. These criteria are used as guidelines, and each client will be assessed on an individual basis.

Please note: Completion of this application does not ensure acceptance into the program.

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Rider Criteria

  • Must be able to maintain a sitting position while the horse is in motion
  • Minimum recommended age of 5 years
  • Seizures must be controlled by medication
  • Maximum recommended weight of 165 pounds
  • Negative finding of Atlantoaxial Instability (For persons with Downs Syndrome)
  • Riders accepted into the program are done so on a trial basis

Rider Information

Please note that all fields are required.

Day Preference:

Indicate your preferred days and times below.

Whitemud Equine Centre:
Tuesday AM (Adult)
Tuesday PM
Wednesday PM
Sunday AM
Sunday PM

Personal Information About the Client:

First Name:
First Name:
Last Name:
Date of Birth:  (DD/MM/YYYY)
Disability:
Height:
Weight:  (pounds)
Ambulatory Status:
Is a Personal Aide Required?  

Questions or Comments

Contact Person for the Client:

First Name:
Last Name:
Address:
Address (cont'd):
Postal Code:
Email Address:
Phone Number (Day):
Phone Number (Evening):
Fax (Optional):