Rider Enrollment

WELCOME Riders!!

This year, we are excited to announce Riders’ Roundup, an opportunity for you to get reacquainted with friends and staff, learn about new programming, and most importantly, enroll in 2012 classes.

Choose one of these dates below (all on Fridays):

March 16th, March 23rd, or March 30th, 2012

Open House between 5:00 – 7:00pm

*Round-ups required for ALL students, whether returning or new.

Activities at the Round-Up include:

• Orientation and registration for classes

• On-site physician available for physician statements and to provide exams for scripts for OT/PT *

• Chance to purchase helmets.

• Information on Scheduling, Scholarships, and Riders’ Campaigns

• Social Network Updates

• Cheryl will be on-site to fill you in on Insurance, Billing, and Payment policies

• Tack fitting, Helmet Fitting, and Horse Assignments

• Basic overview of Safety Rules and a look at New Programs at HHTRC

• Parental Involvement at HHTRC 

• Information on HHTRC Committees and Events in 2012

From American Royal parade

From Hawaiian Week 2011

Meet your fellow riders, and Enjoy great snacks and fun!

Register Using the Form Below

Reminder: Enrollment Fee and First Month of Payment can be paid with your registration. Enrollment fee due when you enroll. Please be prepared to pay the first month of classes payment due by your chosen Round-Up night.

Rider Enrollment:

Name of Client (required)

Parent/Guardian Name (required)

Email Address(required)

Address (required)

City(required)

State(required)
---MOKS

Zip(required)

Home Phone(required)

Alternate Phone(required)

Emergency Contact Name (required)

Emergency Contact Relationship (required)

Emergency Contact Phone (required)

Participant's Date of Birth (required)

Gender (required)
---MaleFemale

Participant's Diagnosis (required)

Date of Diagnosis (required)

Program of Interest (required)
---General PublicHippotherapyTherapeutic RidingCarriage DrivingDon't Know

Type of Payment (required)

 Insurance Billing DMH Private Pay Don't Know

If you checked Insurance Billing above, please list your carrier:

Type of lesson (required)
 Hour long group lesson Private lesson Don't Care

Father's Occupation (required)

Father's Employer (required)

Mother's Occupation (required)

Mother's Employer (required)

Does your work provide matching grants or contribute to United Way of Greater Kansas City? (required)
 Yes No Don't Know

How were you referred to the Center?

Would you like to receive our newsletter?
Yes! Send me quarterly updates. 

Please select one of the following dates to attend the Riders' Roundup
March 16 March 23 March 30 None of these dates work for me 

(REQUIRED) By checking the box below I understand that additional release forms and documentation will be required if I continue the enrollment process at Helping Hands Therapeutic Riding Center

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Note: After clicking the SEND button and receiving confirmation, then proceed to payment options below.

Please select the amount you wish to pay:

Rider Enrollment Fee ($30.00)