Intent To Test (ITT) Form

This form must be filled out by all Upper Level Testing candidates looking to test   It needs to be submitted to Rae Birr, Lake Shore Region Regional Supervisor by October 15th, the year prior to the year you wish to test.  This includes HB, C3/C+, B, H-HM/H/HA, and A candidates.  Questions or comments?  Please contact Marlie Nauta, Lake Shore Region Regional Instructor (RIC) via email at mvbirr@gmail.com.
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Miscellaneous Forms (Farm Releases, Chaperone Form)

Bittersweet Farm Waiver/Release Form
Misty Morning Farm Waiver/Release Form
Racine County Pony Club Equestrian Center Waiver/Release Form
Chaperone Form (for rallies, NOT for camp, use camp chaperone form in Camp Book)

Lake Shore Region Concussion Information & Forms

WI Concussion Act
Explanation of WI Concussion Act
LSR Concussion Fact Sheet
LSR Concussion Parent-Athlete Acknowledgement Form  All riders must have a copy of this form on file for the year with Lake Shore Region (LSR) and their club in order to participate in mounted activities)
YouTube video on concussions

Lake Shore Region Certification Feedback Forms

Lake Shore Region is attempting to improve our certification process by providing constructive, helpful feedback to our examiners and clubs regarding the testing process. Please use the forms below to provide thoughtful comments regarding today’s certification process.

Examiner Feedback Form for Testings

Club Feedback Form for Testings

Beyond the Rally: What’s Next for Older and
Upper Level Members?​