Living Streams Ranch Participant Application
I’m Living Streams Ranch serves women (age 13+) and children (age 8-12) by promoting healthy physical, emotional, and spiritual flourishing after experiencing trauma and difficult life challenges. There is no fee for attending sessions. 

Please complete the following information regarding the individual who is being considered for participation.

NOTE     **** SPRING 2025 Sessions Are FULL, no more available*****

****  SUMMER 2025 Sessions are FULL, no more available***** 

If the season you previously selected is full, you do not need to complete a new form. You will be transferred to the list for the next season automatically, and we will reach out to confirm your continued availability. All applications are date/time stamped, and we give priority to applications in the order they are received and in consideration of an individual's availability. 
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Email *
Participant's First Name *
Participant's Last Name
Program Availability
Living Streams Ranch participants will attend one-to-one sessions that last up to two hours a week, for 8-10 weeks, with sessions being offered in the spring, summer, or fall.  Please indicate all of your availability for the Season for which you are applying. 
Which season would the participant like to attend?   *
Please select all time frames that would work for the participant. 
10 am
12:30 pm
3:00pm
4:00pm
Monday
Tuesday
Wednesday
Thursday
Age *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Required
Do you think of yourself as Hispanic, Latino, or Spanish? *
Required
How would you describe yourself? *
Required
Contact Information
Please provide contact information for the participant. If the participant is under age 18, please provide the contact information for the adult caregiver who is the best point of contact. 
Caregiver's First Name (for dependent participant)
Caregiver's Last Name (for dependent participant)
Is the above adult the legal guardian for the minor/ dependent participant? 
Clear selection
If no, please explain the relationship you have with the participant.
Mobile Phone Number  *
Is it okay to text or leave messages at this number?  *
Email *
Do you understand and agree that by applying to participate at Living Streams Ranch, you will receive electronic communications from the Ranch?  *
Street Address *
City *
State *
Zip Code *
County *
Emergency Contact
Every participant must choose someone who will be locally accessible in case of an emergency at the ranch. Participants under the age of 13 must have a caregiver remain on the ranch property during their session. 
Emergency Contact First Name *
Emergency Contact Last Name *
Emergency Contact Mobile Phone Number *
Family Information 
Please share the following information regarding the participant's family. 
Please list adult family members that live in the household with the participant. 
Family 1
Family 2 - if shared custody
Husband
Biological Father
Biological Mother
Step Mother
Step Father
Adoptive Mother
Adoptive Father
Boyfriend/Girlfriend of Parent
Grandmother
Grandfather
Foster/ Kinship Father
Foster/ Kinship Mother
Other
Clear selection
Please share names of siblings (if participant is a child) or children (if a participant is a parent) that currently live in the household with the participant and their ages. Specify Family 1 (F1) or Family 2 (F2) if child participant is a member of both households due to shared custody. 
What was the combined income of all members of the participants primary household? (This information is helpful for LSR to know so they can apply for funding to support the Ranch.  It is not used to determine eligibility for the participant.) 
Participant Description
The following information will help us have a better understanding of the concerns and life challenges of the participant as well as helping the Ranch determine how we can best serve them. 
Participant has a HISTORY of: (select all that apply)
The participant CURRENTLY struggles with: (select all that apply)
Has there been a recent event that has amplified any of these issues? Briefly explain. 
Has the participant been arrested or incarcerated? 

 *
If yes, please give an explanation of the circumstances and dates related to the arrest/ incarceration.
Please indicate any situations that staff should be alerted to concerning custody or protection from abuse orders. 
Does the participant have any physical health challenges that would impact their ability to fully participate in our program? Explain. 

 *
Individuals weighing over 200 pounds can participate in most equine activities but will be unable to ride due to safety risks for the participant and our herd. Please indicate your situation.
Note: Riding is never a requirement of program participants. 
 *
Required
Does the participant have any allergies to insects, animals, shampoo, paint, soap, fly spray, or peanuts?  *
Please explain any specific instructions for care related to allergies, including if an epi-pen should be brought to the session. 
Please describe any additional mental health challenges or diagnosis of the participant that would be helpful for us to be aware of in order to better serve the participant? 
Has the participant had a negative experience around animals? 
Clear selection
Has the participant ridden a horse previously? 
Clear selection
To help maintain safety around horses, it is important that the participant be able to understand and comply quickly with  instructions given by our staff. Would this be a problem for the participant?  *
Please share any concerns about the participants communication skills that would be important for Ranch staff to know.
What is the best calming approach for the participant? 
What are three goals you have for participating in the program at Living Streams Ranch?  *
Required
Is there any other information about the participant's situation that would be helpful for us to know?
Please indicate understanding and agreement to the goal and scope of the program: 
Living Streams Ranch utilizes Bible study, prayer, and learning about faith in Jesus as core components of each session. Our session leaders are Christian mentors that will meet one on one with participants, incorporating Biblical truths into activities with our horses that help promote healing to the whole person.  While a participant may ride a horse at some time during sessions, Living Streams Ranch is not providing riding lessons or formal equine therapy. 
 *
How did you first learn about Living Streams Ranch? 
Clear selection
If you have an affiliation with a local faith community/ church in the area, please share their name.  
In the event of an emergency, which local hospital would you prefer to use?
Our sessions are offered at no cost to participants. We are requesting that at the end of their season of sessions, participants complete an Impact Assessment  to indicate if their participation in Living Steams Ranch was helpful and in what specific ways. This allows us to help secure funding to keep sessions financially accessible. 
Clear selection
Do you give consent that photos or videos taken during sessions can be used to help further the mission of the Ranch through use on newsletters, social media, website, or other means for marketing or fundraising?  *
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