| Program Application |
| To enroll in any of our programs, please print out this application, complete it in detail and mail it to the address listed above with your $200 tuition* deposit. |
| Your Information |
| Name:____________________________________________________________________________ |
| Street Address:____________________________________________________________________ |
| City, State, Zip:___________________________________________________________________ |
| EMail:____________________________________________________________________________ |
| Home Phone: (________)________________Work Phone: (________)____________________ |
| Date of Birth:____________________________Gender:__________________________________ |
| Occupation:_______________________________________________________________________ |
| Please List Two Equine Industry References (Other than Family) |
| Reference 1 |
| Name:____________________________________________________________________________ |
| Address:__________________________________________________________________________ |
| Phone:________________________________Equine Relationship:________________________ |
| Reference 2 |
| Name:____________________________________________________________________________ |
| Address:__________________________________________________________________________ |
| Phone:________________________________Equine Relationship:________________________ |
| Which classes will you attend? |
| Class & Date:_____________________________________________________________________ |
| Class & Date:_____________________________________________________________________ |
| Class & Date:_____________________________________________________________________ |
| In case of emergency, contact: |
| Name:____________________________________________________________________________ |
| Relationship to Applicant:________________________Phone:___________________________ |
| Street Address:____________________________________________________________________ |
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| City, State, Zip:___________________________________________________________________ |
| How did you hear about our programs?______________________________________________ |
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| Please attach a brief biographical sketch explaining your experience with horses and your motivation for attending our program. Please also send a recent photograph of yourself. |
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 | | Animal Dynamics | | Equine Sports Therapy Programs | | 9791 NW 160th Street, Reddick, FL 32686 | | Phones (352) 591-4735 / (352) 591-6025
Fax(352) 591-0988 | | |
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| *Full payment of tuition is due the first day of class. |
| A $200 deposit is required when you submit your application. Your $200 deposit will be applied to your tuition. |
| In the event that you cancel your enrollment, your deposit is non-refundable, but may be applied to a future class. |
| You may pay your tuition with either a check or credit card. |
| If you send a check, please make it payable to Animal Dynamics. |
| Credit Card Type & Account Number:________________________________________________ |
| Expiration Date: ____________________CVC Code:_____________________________ |
| Applicant Signature & Date:________________________________________________________ |
| Upon receipt of your application, a detailed confirmation package will be sent to you. |
| The package will include recommended travel arrangements, recommended places to stay and directions to our farm. |
| Thank you for your interest, we are looking forward to working with you! |
| PAGE 2 |
| Print Application Form |
