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Therapeutic Riding Lessons

Request a Ride

To request a riding lesson, please fill out the form and a member of our team will contact you.

Riding Lesson Request

Please fill out the following form for the participant. This information will help us understand your needs.

First name

Date of Birth

Last name

Parent or Legal Guardian

Phone

Address

Email Address

Emergency Contact (if Parents or Legal Guardians cannot be reached)

Phone

Address

Diagnosis

Date of Onset

Health information: Any concerns or issues riding instructor should be aware of?

Medications:

Goals:

Height

Weight

Initials

Today's Date

Your Signature

I declare that the info I’ve provided is accurate & complete.

Thank you!

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Contact

info@susannafarms.net

24153 W. Townline Rd

Lake Villa, IL 60046

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