Hampshire Riding Therapy Centre Ltd
Registered Charity 1062253
Application Form
(Please complete this form but if you are less than 18 ask your parent or guardian to sign on your behalf)

Title__________First Name_____________________Last Name_______________________________

Age___________

Address_____________________________________________________________________________

____________________________________________________________________________________

Town__________________________ County_________________________Post Code_____________

Telephone____________________________

Mobile_______________________________

Brief reason for applying (eg, Diabetic, heart condition, want to ride, love horses, etc)

Tell us a little about your condition (eg, Been diabetic 1 year, find life a trial, etc)

Tell us a little about your experience with horses/animals (NB: It doesn't matter if you have none it just helps us know your standard.)

?

Tick the box if you think you would be interested in summer camps

?

Tick the box if you think you would be interested in day courses

I would like to apply to be a pupil at Hampshire Riding Therapy Centre Ltd.

Signed_____________________________Date_________________________

Signature of parent/ guardian if the applicant is under 18

Signature___________________________Date__________________________

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