If you are a first time rider please select New Rider Orientation. New Rider Orientations are $45.00 and last about 30 min.
Please allow 20-30 minutes to completely fill out this form. The more information you can give us, the better perpared we can be to serve you upon arrival. Once your application is received, you will be contacted to schedule a New Rider Orientation.
Rider Sessions
First Name:
Last Name:
Email:
Home Phone:
Phone 2:
Home Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip:
-
Zip Suffix
Riders First Name
Riders Last Name
Riders Birth Date
Riders Age
Disability or Diagnosis
Any Limitations?
Riding Experience.
Weight
under 30 lbs
Between 30 and 50 Lbs
Over 50 lbs
Over 100 lbs
100 - 150lbs
150 - 160 lbs
160 - 170 lbs
170 - 180 lbs
180 - 190 lbs
200 lbs
Over 200 lbs
Any Food Allergies?
Down Syndrome Diagnosis
Yes
No
Negative Cervical X-Ray for Down Syndrome Diagnosis
Yes
No
Other Therapies
Mobility: Can rider walk on own? Do they need assistance sitting? Wheelchair? Please describe rider's mobility
Is rider able to express themselves verbally?
Yes
No
Has rider been diagnosised with Epilepsy?
Yes
No
What are some positive re-enforcers rider likes?Praise, high-five, thumbs up?
Describe rider's attention span?
Any visual limitations?
Yes
No
Any hearing limitations?
Yes
No
Any Speech limitations
No
Non-verbal
Delayed Speech
Selective Mutism
Other
What are rider's favorite hobbies/interests?
What goals would you like to see rider accomplish while riding with Silver Lining Riding?
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