New Rider Form

New Rider Form

Thank you for your interest in Divine Please fill out the form below,
Contact Information
Name of Parent to contact:
Client's Name *

First Name Last Name
Billing Address *

Street Address

Street Address Line 2

City State

Zip Code
County You Reside In

Grayson Fannin Collin Cooke Byrant OK
Home Phone Number *

Area Code Phone Number
Mobile Phone Number

Area Code Phone Number
E-mail *
Is the participant under the age of 18?

Yes No
Prefered Method of Contact

Home Mobile E-mail
Client's Information
Date of Birth *

Month Day Year
Height *
Weight *
Primary Disability
Secondary Disability
How did you hear about us? example: TCC- CASA- Probation - Other
Day your requesting

Monday Tuesday Wednesday Thursday Friday Saturday
Monday Tuesday Wednesday Thursday or Friday Times your interested in depending on Instructor availability

9:00 - 10:00 10:15 - 11:15 11:30 - 12:30 1:00 - 2:00 2:30 - 3:30 4:00 - 5:00 5:15 - 6:15 Veterans only on Friday nights 6:30 - 7:30
Saturday's Times your interested in depending on Instructor availability

9:00 - 10:00 10:15 - 11:15 11:30 - 12:30 1:00 - 2:00
What Program are you Interested in

Equine Riding Services Equine Facilitated Psychotherapy Veteran Program
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