Rider Application
*Riders must be between 2 - 18 years of age at the time of riding sessions.

** Applications for the next upcoming sessions will remain open until our application deadline has past. Applications for Spring Sessions are accepted from the second Tuesday in October until the third Tuesday in April and for Fall Sessions from the fourth Monday in May until the second Tuesday in July.

After the deadline has passed, our board will review all applications received.  A letter will be sent to you a couple weeks prior to the first session if the applicant will or will not be accepted into the program. **

Session Locations subject to change: Our Spring and Fall Sessions are typically held at the Clay County Fairgrounds in Spencer, IA

Website: reinsofhopespencer.org
Contact Us: reinsofhopespencer@gmail.com
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Email Address *
Primary Parent / Guardians First & Last Name *
Telephone Number: (Format: 123-456-7890) *
Additional Parent/Guardian First & Last Name
Additional Parent/Guardian Telephone Number: (Format: 123-456-7890)
Full Mailing Address *
Participants First & Last Name *
Participants Date of Birth *
MM
/
DD
/
YYYY
Participants Diagnosis. Also please explain or describe the diagnosis to help us better understand this condition. *
To aid their experience, please share more specifics that may aid our understanding of their condition such as triggers/preferences/therapies, etc. *
Participants Impairments: *
Required
Are braces or other assistive devices used? *
Medical history you think is pertinent: (ie. seizures, breathing trouble) *
Participants Height *
Participants Weight *
Participants T-Shirt Size
**Due to the number of applicants, should your applicant not be chosen to participate, would you be willing to be placed on a wait list? This means you would agree to complete the Physician Referral form to have on hand and be contacted should a scheduled participant not be available for a session. All applicable forms must be completed to participate.  
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Inquiry Source
***Once the application deadline has passed and our review process has been completed by our board members, we will notify you of your applicants participation status. This is typically a few weeks prior to the start of the next Session. Thank you!
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