Horses For Hope - Therapeutic Riding Request Form

Problems using this form or need to update a record that already exists in our database? Please send EMAIL for assistance!

NOTE: Supported web browsers include reasonably recent versions of the following: IE 9+, Firefox, Chrome, Safari, Opera, iOS, and Android. See this link for details on browsers supported by jQuery 2.x!

Please tell us a bit about the rider:

NOTE: Horses for Hope considers the safety of our riders and our horses as our top priority. We reserve the right to limit the age and weight of our riders. Should such limitations apply, we will try to provide an alternate solution.

(First) (Middle) (Last)
Yes No       Help

Parent or Guardian if under age 18 or if rider is in full-time care:

Contact #1:

( -
Allow text messages? Help      Carrier

Contact #2:

( -
Allow text messages? Help      Carrier

Rider Availability:

When are you available to ride? Check all that apply:

Select Description

Which program would you prefer? Go to our web site for more information about each of these programs.

Select Description

Please Confirm Your Registration Info:


Name: DOB:
Height (in): Weight (lbs):
Diagnosis: High-functioning?


Contact #1 Name:
Text Msg Carrier:

Rider Availability

Selected Availability:
Selected Program:

By clicking the REGISTER button, I acknowledge that I am requesting placement on a waiting list for the selected therapeutic riding program but that some prospective participants may not qualify to ride due to certain contraindications that may exist.