Southern Reins 2021 Adaptive Riding Session Sign Up Form
Use this form only if you have complete the Participant Registration Packet and have had an assessment with an instructor at Southern Reins Center for Equine Therapy. Contact Program Director, Sara Zurenko at
for more information.
All participants will be required to have a credit card on file. We will call you for the information. The credit card will be charged one (1) week prior to the start date of each session for half of the session fee. The remaining half of the session fee will be processed during the 5th week of the session. The total amount for each payment processed will be $258.90, which includes credit card processing fees.* The credit card information you provide to Southern Reins will be securely stored and will remain confidential. We maintain physical, electronic and procedural safeguards to protect your information, and our employees are required to follow these privacy standards.
*Payment amount may vary if credit card processing fee amounts change
Should you need to make alternative payment arrangements, such as paying with cash or a check, you must submit a written request to the Program Director, Sara Zurenko, no later than the date that registration closes for that session for consideration.
Fall Session – 10 weeks September 27 through December 11
No lessons November 22 through November 27
Makeup Week: December 13 through December 18
Registration closes September 6, 2021
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Name of participant:
Please provide at least 2 day and time options that work best for you or notify us that you wish to keep the spot your participant is currently scheduled for here. We have lessons that start from 10:00 am until 5:30 pm most weekdays and possibly Saturdays.
Please confirm that you have your participant paperwork up to date including physician statement:
My paperwork has been reviewed/updated within the year and my physican statement is current (updated every 2 years, except for participants with Down Syndrome which requires a yearly statement)
I do not know if my paperwork is up to date and need to verify.
Send me a copy of my responses.
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This form was created inside of Southern Reins Center for Equine Therapy.