Participant Registration Forms

 

Dear Rider Applicant,

Thank you for your interest in riding with Acadiana Therapeutic Riding Organization. Although the application process can appear to be very intimidating, I will do my best to assist you with completion of the necessary forms.

In your packet, which you will download, will be several forms. Each one is a vital part of the application process. First, you will complete the Participant’s Information Form and Health History. This form contains general information such as your name, address, date of birth, employer (if applicable), Parent or legal guardian, if the applicant is a minor, and health history, with any recent tests that you may have had. We would like for you to include such information as allergies, current medications, and information about your vision, hearing, communication, etc.

We would then like some information on the second page which will tell us a little bit about your function, ability to walk, transfer, and any assistive devices that you may use, such as crutches, wheelchairs, etc. Social information will tell us a little bit about what grade level you have completed, support structure, and what fears or concerns you may have. Finally we would like for you to identify some goals that you would like to have the riding program help you achieve.

Please sign the photo release for consent to have your likeness used in our program on the web or facebook pages, if you so desire.

There are two additional pages to be completed by your physician with a cover letter to explain to the physician the conditions that may not be appropriate for therapeutic riding. Once this is received, a pre ride assessment may be scheduled to determine other factors which may impact you as a student. The assessment will be performed by a certified riding instructor with possible input from a physical therapist, if your condition warrants.

The Authorization for Emergency Medical Treatment form should also be completed with your insurance information and consent for treatment or non-consent. This form must be completed yearly or whenever your insurance information changes.

The final two forms are releases of liability for Cherokee Ridge Equine Farm and Acadiana Therapeutic Riding Organization. These must be completed and returned with the rider application packet .

Please forward your application to ATRO, c/o Physical Therapy Works, 103 Westmark Blvd., Suite 4, Lafayette, LA 70506. Once received, you will be contacted about your application and a pre ride assessment scheduled if necessary.

Thank you for your interest in our organization. If you have any questions regarding the application process, please call Lorain or Emily at 337-988-4444 or send us an email.

 

Lorain Gilbert-Fontana, PT, MHS