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Therapeutic Riding Summer Series 2018

This programs serves children and adults with disabilities and runs on Tuesdays starting May 29th- July 17th. All NEW participants must pay a $15 Registration fee. Each session cost $35/session. Also, all NEW participants must have a Medical Consent Form signed by their physician as well as a guardian signed liability release form.

June and July will have a special feature each Tuesday! Starting June 12th, all sessions will start in the morning and be finished by 1:00.

Client Information

Client Name

First Name

Last Name

Client Date of Birth

00/00/0000

Guardian Name

First Name

Last Name

Guardian Email

Verify Email

Guardian Phone

Client Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Guardian Address if different that client's

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Referred By:

Medical Consent Form Information

As a courtesy to our clients, the Ranch will fax over the Medical Consent Form to the client's physician.

Physician's Practice and Name

Physician's Fax Number

Optional Upload: Signed Liability Release Form File Upload

Use this to upload your completed liability release form

Optional Upload: Signed Medical Consent Form File Upload Copy

Use this to upload your completed Medical Consent Form

Payment

Payment Options

Click Pay online for immediate payment. Click on Pay by Check/Cash. Mail or Drop off the payment to Bit of Hope Ranch, 5001 CR Wood Rd Gastonia, NC 28056

Pay Online

Pay by Check/Cash

Credit Card Payment

$15 - Registration

$45 - Registration + 1 Session

$35 - 1 session

Payment by Check or Cash

Mail or drop off payment to: Bit of Hope Ranch 5001 CR Wood Rd Gastonia, NC 28056

$15 Registration Fee

$45 Registration Fee + 1 Session

Other