Centered
Riding® Instructor Course Application
Please review the requirements to become a Centered Riding
Instructor which can be found at http://www.centeredriding.org (Look under
"Instructors”) Please complete this
application and return it to the Clinic Organizer at least 2 weeks before the
clinic. The Clinic Organizer must send a
copy of each Instructor Application to the Clinic Instructors before Part I of
the Course.
Course Location: __________________________
Date of Course: ____________
Applicant’s Name: _________________________________________________________________
Date of Birth: (month/day/year) ______________________ (must be 18 years old at time of course)
Street Address:_________________________________________________________________
City: (note: include postal code if it
precedes city): ____________________________________
State/Prov: _________________
Zip/Postal Code: ____________ (enter
only if it follows city,state or prov.)
Phone: (include country code for foreign nos.) ______________________Fax: __________________
Email: __________________________________ Cell Phone: ____________________________
____ I have ridden in at least one two- or
three-day Centered Riding Open Clinic or two or more one day
Open Clinics and am attaching a copy of the Certificate of Participation
from this clinic (NOTE: If
you do not have a Certificate of Participation, please provide the
information below:
Date:___________ Location: ______________________Clinician:
_______________________
Date:___________ Location: ______________________Clinician:
_______________________
OR
I have had _________ Centered Riding® lessons from the following Level III, Level IV Apprentice
or
Level IV Clinician: (Name):________________________________________________________
(Note: In order to take the Instructor Course, one of the following is required:
Participation in a 2 day Open CR Clinic, OR 6
Centered Riding lessons and a written recommendation from a Level III Clinician, OR 4 Centered Riding lessons and a written
recommendation a Level IV or Level IV Apprentice.)
___I have taught riding for at least one
year
___I am able to ride with good form and control in a group at walk, trot/jog,
& lope/canter (any discipline) and execute schooling figures and
ride over ground poles.
Do
you have any disabilities, limitations, or problems, which the clinic
instructors should be aware of (injuries, taking medication, etc.)? If so,
please describe:
Which disciplines do you ride, teach,
and/or compete in? To what level? What is your primary discipline?
___Dressage:
___Hunt seat:
___Combined Training / Eventing:
___Western:
___Saddle seat:
___ Distance riding:
___Pleasure/recreational riding:
___Therapeutic riding:
___Other (describe):
Please
answer the following questions: (use back if more room is needed)
Please describe your riding level,
experience and training in horsemanship.
Please describe your experience and
training in teaching riding and your education.
What are your long-term goals in
horsemanship and teaching riding?
What experience have you had with
Centered Riding® and body awareness methods?
(Important!) What do you hope to learn
from the Centered Riding Instructor Course?
Please
return this application to the clinic
organizer listed on the CR website for the clinic you wish to attend.
Contact the clinic organizer with any questions you have as to costs,
accommodations and procedures that will take place at the clinic.
Centered
Riding®, Inc.
P.O. Box 429, Millstone
Township, NJ 08510-0429
Phone: 609-208-1100 / Fax: 609-208-1101
www.centeredriding.org
/ office@centeredriding.org
(Rev. August 2013)