Therapeutic Riding/Driving Forms:

Please note that the follow forms are available in hard copy and can be filled out in person or mailed/emailed upon request.

Therapeutic Riding/Driving Application Packet

Scholarship applicationIf you require financial assistance to help pay for fees, please complete this form in entirety. — **Scholarship application**
If you require financial assistance to help pay for fees, please complete this form in entirety.

Annual information updateUpReach needs to keep our files current. Please complete this form annually and inform us of any medical changes. — **Annual information update**
UpReach needs to keep our files current. Please complete this form annually and inform us of any medical changes.

Physician statement updateWe require your medical information be updated annually to ensure it is safe and appropriate for you to participate! — **Physician statement update**
We require your medical information be updated annually to ensure it is safe and appropriate for you to participate!

I Have questions:

Should you have any questions/concerns regarding the application process, forms, or if you wish to arrange a visit, check on the wait list status, please fill out the form to the right or give us a call at 603.497.2343. Thank you!

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Program

Therapeutic Riding

Therapeutic Driving

Message

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Therapeutic Riding/Driving Paperwork