Personal Information

Name *

Email *

Phone *

Street Address *

City State Zip *

Date of Birth *

Horsemanship Information

Are you a Parelli Member? If so, please list your membership number. *

What is your level "OnLine" (Playing with and controlling your horse in a halter and rope)? Choose from drop down list. Parelli Level 1 Parelli Level 2 Parelli Level 3 Parelli Level 4 Non-Parelli Beginner Non-Parelli Intermediate Non-Parelli Advanced *

What is your level "FreeStyle" (Riding without contact on the reins)? Choose from drop down list. Parelli Level 1 Parelli Level 2 Parelli Level 3 Parelli Level 4 Non-Parelli Beginner Non-Parelli Intermediate Non-Parelli Advanced *

What is your level at "Liberty" (Playing with and directing your horse when he's loose or in a round pen)? Choose from drop down list. Parelli Level 1 Parelli Level 2 Parelli Level 3 Parelli Level 4 Non-Parelli Beginner Non-Parelli Intermediate Non-Parelli Advanced *

What is your level in "Finesse" (riding with rein contact/collection)? Choose from drop down list. Parelli Level 1 Parelli Level 2 Parelli Level 3 Parelli Level 4 Non-Parelli Beginner Non-Parelli Intermediate Non-Parelli Advanced *

What is your confidence level with horses while on the ground? Choose from drop down list. Fearful much of the time 1 2 3 4 Neutral 5 6 7 8 9 Fearless! 10 *

What is your confidence level while riding? Choose from drop down list. Fearful much of the time 1 2 3 4 Neutral 5 6 7 8 9 Fearless! 10 *

What activities do you do with your horse on a regular basis? (500 chars left) *

Do you have any physical or emotional conditions which affect your horsemanship? (500 chars left) *

Your Horse

Horse Name *

Breed - Age - Height *

What is your horse's level of training? (500 chars left) *

Has anyone ever been injured with this horse? (If yes, please explain.) (500 chars left) *

Your Learning

What are your long term horsemanship goals? (500 chars left) *

What do you hope to get out of our sessions together? (500 chars left) *

How do you learn best? Choose from drop down list. Kinesthetic - By doing and experiencing. Visual - By watching or reading. Audible - By listening and discussing. Knowledge - By gathering details and understanding systems. *

Which most closely describes your personality type? Choose from drop down list. Competitive,Playful,Adventurous,Direct Active,Sensitive,Outgoing,Passionate Quiet,Intuitive,Nurturing,Cautious Confident,Thoughtful,Strong,Logical *