2020 Spring Equine Assisted Learning Lesson Registration – Flying Manes Therapeutic Riding

2020 Spring Program Registration (60) (unmounted)

Participant Information

Please complete the form below.

Participant Name *

First

Last

Date of Birth *//

Weight (lbs) *

Height (feet, inches) *

Primary/Secondary Diagnosis *

First Parent/Guardian Name *

First

Last

Email *

Phone *

Second Parent/Guardian Name *

First

Last

Email *

Phone *

Please note any limitations for lesson start/end times or scheduling conflicts you may have:

Are there any special considerations you would like us to keep in mind?

Do you have any other suggestions or comments for us?

Lesson Fee Payment

Please complete your registration by paying the program lesson fees ($570.00) through PayPal.

Program Lesson Fees (60 minute lessons) *

Please complete your registration by paying the lesson fees.

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