www. wsca. org 2025- Champ Show Special Edition- 20
Western Saddle Clubs Association Adaptive Riding Physician Referral Form
Adaptive Riding is a branch of Equine-Assisted Services in which riders with some form of physical, emotional, or developmental disability are assisted in order to safely participate in equestrian activities.
Participant Name:__________________________________________________________________ Guardian Name:____________________________________________________________________ Participant Address:_________________________________________________________________ Participant Phone:( home)_________________________________( cell)_______________________
Participants with limitations in the following areas generally qualify for inclusion in Adaptive Riding Programs. Many riders will require the assistance of a horse handler or support assistants. Riders might require adaptive equipment to allow them to safely compete. Riders might also be able to ride without an assistant at their side, while still requiring the support of a trainer or device in the arena to compete.
Below, please find an array of areas which qualify a participant to compete as an Adaptive Rider. We do not require the disclosure of a diagnosis.
Seizure Disorder Independent Ambulation with Restriction Assisted Ambulation Downs Syndrome Atlanto-Axial Instability Auditory Special Needs Visual Special Needs Special Needs Regarding Tactile Sensation Cardiac Condition Circulatory Disorder Integumenatry / Skin Condition Immunity Condiiton
Balance Disorder Orthopedic Condition Allergy Condition Learning Disability Cognitive Disorder Emotional Disorder Psychological Disorder Participation in Special Education Classes Pulmonary Condition Neurologic Condition Muscular Condition Other
The above-named participant is not precluded from participating in Adaptive Riding Activities.