Enroll

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.

The next Rider’s Round-Up will be held on JUNE 1st, 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
  • 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 Hawaiian Week 2011

Register Using the Form Below

Reminder:Enrollment fee due when you enroll.  First Month of Payment can be paid by cash, check, or online via Paypal during the Rider’s Round-Up.

Rider Enrollment:

Name of Client (required)

Parent/Guardian Name (required)

Email Address(required)

Address (required)

City(required)

State(required)

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)

Participant's Diagnosis (required)

Date of Diagnosis (required)

Program of Interest (required)

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?

Please select one of the following dates to attend the Riders' Roundup
June 1 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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