APPLICANT INFORMATION
Name:__________________________________________
Age:______ Phone:_____________ Cell:____________
Address:________________________________________
City: ______________ State: ______ Zip: ______________
Email Address: ________________
Do you plan to attend as a Student or as a Students Assistant ? ______________
If you are attending as a Students Assistant, please state
the name of your qualifying Student ? _______________
EMERGENCY CONTACT
Name: _________________________________________
Address:________________________________________
City:______________ State: _______ Zip: ___________
Relationship: _______________
Home Phone: _______________
Work Phone: ________________
Cell Phone: _________________
Other: __________________________________________
HORSE INFORMATION
Both States of Minnesota & Florida requires State Certified proof of Negative Coggins and a State Certified health certificate for your horse within the past 30 days before permitting entry into Minnesota or Florida. Please bring both certificates with you if you plan to attend with a horse. Please initial here: _________
Name of Horse: ______________________
Breed of Horse: ______________________
Age of Horse: ______________________
Color of Horse: ______________________
QUESTIONAIRE
Do you have any disabilities that we would need to assist you with ? _____________________________
If so, what type of assistance could we help you with ?
_____________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
Are you bringing a horse ? __________
Do you need us to provide a horse for you ? _________
What breeds of horses do you like to work with ?
________________________________________________________________________________________________
What do you know about the background of the horse you are bringing
such as bad habits, problem areas, attitude, physical limitations or abilities and accomplishments ? ______________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
What is your experience with horses ? _______________________________________________________________________________________________________________________
Have you ever attended or been involved with any other horse related program ? __________________________
If so, who and where ? ________________________________________________________________________________________________
Did you graduate from the program ? ________________
Did you leave satisfied with the program ? ________________________________________________
How many students are accompanying you for this course ? ________________________________________
When you learn the amazing results we guarantee in this program,
would you like us to advertise your training and education with us at no cost to you in your local newspaper ? ______________________________
If so, please provide us with the Name, City & State of your local newspaper : __________________________________________________________________________
