2024 Riders Up Enrollment Form

Student Name

First Name

Last Name

Student's Age

School

Grade

Parent/Guardian's Name

First Name

Last Name

Relationship to Child

Cell Phone

(###)

###

####

# of People in Household

What services are you interested in?

Therapeutic Riding Lessons

Horse Boy Method - Autistic

Low Income

Medical Information

Please provide student's height, weight & primary diagnosis. Please provide any other behavior/cognitive information we may need to know that may affect the child's behavior or ability to learn in lessons.

Other Extracurricular Activities

Riding Experience

None

Minimal

Moderate

Extensive

Has student ridden at any other equestrian or therapeutic riding facility?

Yes

Message

Please provide any other information that would be helpful to know about the student.

Name

By signing here prior to submitting, you are consenting to the Cancellation Policy below as well as the Texas Farm Animal Professional Liability statement below.

First Name

Last Name

Cancellation Policy

24-hour notice is required for the cancellation of any lesson regardless of the reason. If canceling with 24+ hour notice, the lesson can be rescheduled within the same calendar month. If canceling with less than 24-hour notice, the lesson will not be rescheduled and payment will still be required. No shows will also not be rescheduled and payment will still be required. After two No Shows, student will be removed from the program.

WARNING

UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), A FARM ANIMAL PROFESSIONAL OR FARM OWNER OR LESSEE IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN FARM ANIMAL ACTIVITIES, INCLUDING AN EMPLOYEE OR INDEPENDENT CONTRACTOR, RESULTING FROM THE INHERENT RISKS OF FARM ANIMAL ACTIVITIES.

2024 Riders Up Enrollment Form

Cancellation Policy

WARNING

Lake Fork Stables