American Association of Equine Practitioners

Name*

Farm/Business Name*

Website Address

Farm/Business Physical Address*

Street Address City/Town State ZIP / Postal Code

Mailing Address (if different than above)

Street Address City/Town State / Province / Region ZIP / Postal Code

Business Phone Number*

Cell Phone Number*

Email*

Number of lesson horses:

Primary Instructor’s Name (if different than above)

Organization Name*

Please attach a copy of your current membership card

Accepted file types: pdf, jpg, gif, png, Max. file size: 300 MB.

Please attach a copy of your SafeSport training certificate

Accepted file types: pdf, jpg, gif, png, Max. file size: 300 MB.

*Not familiar with Safe Sport? No problem - we’ll send you information.

Please attach proof of a clean criminal background check dated within two years

Accepted file types: pdf, jpg, gif, png, Max. file size: 300 MB.

*No background check? We’ll send you information on how to complete this important step.

Please attach a copy of your Liability and Waiver form, or email to: ttr@horsecouncil.org

Max. file size: 300 MB.

Please attach a copy of your Certificate of Insurance, or email to: ttr@horsecouncil.org.

Max. file size: 300 MB.

*The COI must include American Horse Council as an additional insured.

By submitting this application I certify that the equine facility named above meets all Time To Ride Program Facility barn and property requirements, and that the individual(s) named above either meet or will take the necessary steps to meet the Staff/Horsemanship requirements.

Name*

Date*

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