This form is completed by Riders withing to borrow a horse.

Rider Name________________________________________________________ Sex:_______ Age:___________

Who can we call with questions?__________________________________________________________________

Telephone #__________________________________________ Fax #__________________________________

Disability:________________________________________________ Height:________ Weight:______________

Skill Level: Walk,   Min Trot,   Int Trot,   Adv Trot,   Canter,   Adv Canter.

Number of Aides: Three,  Two,  One,  None, 

Riding Style: English Western

# Years Riding:_______________ Average length of Riding Session:___________________________________

Mobility: Power Chair,  Manual Chair,  Crutch/Cane/Walker,   Independent Other:_______________________

Type of Horse Barrel: Narrow   Medium  Broad   Any;  Size in Hands:_________

Type of Trot: Very Smooth   Elastic/Springy   Very Springy   Any Rider   Cannot Post

If possible, Riders should bring saddle and adaptive tack. Riders without a coach must have prior approval to compete. Please phone Anita Hartzell at 504 466 9960 evenings or weekends.

I plan on riding in the following classes:

EQUITATION, DRESSAGE, FUTURES, OBSTACLE, POLE BENDING, COSTUME

Please provide any additional information so we can make you a good match.