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Gracewood Farm Gaited Horsemanship Lessons - 2008
Rider and Horse Information Sheet
In order to best instruct you during your horsemanship lesson(s), please provide the information you feel may be important for the instructor to know.
Rider:____________________________ Nickname: ________________
Mailing Address: ______________________________________________
City: ________________________ State: _________ Zip Code: ________
Age: _________ Height: __________ Weight: _________
1. Do you have any physical or mental handicaps that could be relevant to
taking horsemanship or riding lessons? (Example: Dizziness, headaches) ____________________________________________________________________________
2. Are you taking any medications that could affect you during the lesson?
__________________
3. How much riding experience do you have, and how recent? _________________________
______________________________________________________________________________
4. What breeds of horses have you ridden? ____________________________________________
5. What level skill do you consider yourself a rider? Beginner ____, Novice
____,
Advanced Novice ___, Intermediate ____, Advanced Intermediate ____, Advanced
____
6. What are your short-term goals for horsemanship riding lessons? _____________________ _______________________________________________________________________________
7. What are your long-term goals for taking horsemanship riding lessons? _______________ _______________________________________________________________________________
8. Do you have an ASTM/SEI approved safety riding helmet and riding boots with a low heel (no athletic shoes) that fit properly for riding during the lesson? ___________
8. Will you be providing your own Horse? _________Yes ________No
Name of Horse: _______________________
Age of Horse: _________________________
Breed of Horse: ________________________
Sex of Horse: __________________
Date of Current Coggins (within 1 year): _______________(Will need to bring a copy)
9. Does your horse have any behavioral habits you should be known prior to the lesson towards other horses or new places? __________________________________________________________________
10. Is there anything specific that you would like to improve while riding
your horse?
____________________________________________________________________________
11. Has your horse been ill within the last month? _________________________________
Did he receive any veterinary treatment, if so? ____________________________________________
12. I s there any special tack or equipment that will be needed with this horse?
__________________
Will you be providing this and what? _____________________________________________________
Date: _____________________________
Rider or Guardian: ________________________________