Has been participating in supervised mounted equine activities at Thorncroft Equestrian Center and is due for an update
of his/her medical status. Please review the previous medical history and provide an update of the information in the
space below. Address occurrences over the past year including surgeries, illnesses, and hospitalizations, changes in
medications, treatment, weight or behavior. Please indicate current height/weight. If this person has Down syndrome
or any other condition that predisposes him/her to Atlantoaxial Instability, please include results of his/her neurologic
Given the above diagnosis and medical information, this rider is eligible to continue in mounted equineassisted activities and/or therapies. I understand that Thorncroft Equestrian Center will weigh the
medical information given against the existing precautions and contraindications. I refer this rider to
Thorncroft Equestrian Center for ongoing evaluation to determine continued eligibility for participation.