Chum Therapeutic Riding

Forms and Downloads

Thank you for your interest in our program.  I am looking forward to meeting you and your family and introducing you to our world of horses and therapy.  If attending CHUM for OT services, a script from the doctor specifying “Occupational therapy services” is required.  All participants are required to complete the packet of forms.  The cost for therapeutic riding sessions is $30 per hour, if backriding (therapist/instructor/staff rides behind the participant) services are needed-$45/session, with an annual registration fee of $50.  The cost for therapy sessions is $45.00 per session and OT consult services are $30 per session.  We are no longer accepting new ‘billing to insurances’.

Click on the form name to view and download.

Rider with Disability Forms

• Activity Release

• Down Syndrome Rider Evaluation

• Health History

• Parent-Guardian Release

• Photo Release

• Physician's Referral

• Registration and Emergency Treatment

Volunteer Forms

• Activity Release

• Health History

• Parent-Guardian Release

• Photo Release

• Registration and Emergency Treatment

Rider without Disability Forms

• Activity Release

• Health History

• Parent-Guardian Release

• Photo Release

• Registration and Emergency Treatment

Bonnie's Forms