Therapeutic Riding Wait List Form
The length of the time your child is on the wait list is entirely dependent on their availability and the open lesson times Lovelane has on our schedule. After you submit this form, Lovelane will be in touch if we have an opening that matches your availability. We also will be in touch via email to offer other opportunities for wait list students throughout the year.

PLEASE NOTE THAT LOVELANE USES CONSTANT CONTACT TO COMMUNICATE WITH FAMILIES ON OUR WAIT LIST. IF YOU UNSUBSCRIBE, YOU WILL NO LONGER BE NOTIFIED OF OPPORTUNITIES FOR YOUR CHILD TO PARTICIPATE IN OUR PROGRAM.
Email *
STUDENT INFORMATION
Student Last Name *
Student First Name *
Student Date of Birth *
MM
/
DD
/
YYYY
Gender *
Student Height *
x' x"
Student Weight *
xx lbs
School & Grade *
Student Primary Diagnosis & Disability *
If your child does not have a formal diagnosis, please describe your child and their needs.
Please tell us more about your child: *
What form of communication do they use? Do they use any assistive device for ambulation? Do they have any allergies? Do they have any behavioral issues Lovelane should be aware of? Do they have full vision and hearing capabilities?
Is your child able to wear a mask or face covering? A face shield? *
Does your child have any previous experience with horses or riding? *
If yes, please describe:
Home Address *
# & Street
City & State *
Zip Code *
AVAILABILITY (DAYS)- Please check off all days your child is available to ride: *
Required
AVAILABILITY (TIMES): Please be as SPECIFIC as possible with any time options for the days your child is available. Lovelane holds lessons daily between 9:00am and 6:00pm. *
Example: M, W, F between 2:15 and 6:00 OR Thurs between 9:00 and 12:00
I am interested in having my child participate in the following program(s) at Lovelane: *
Please check all that apply. Visit our website for more information about each program.
Required
Notes:
Any additional information that would be helpful for us to know
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