Healing with Horses Ranch                Participant Application
Healing with Horses Ranch is a 501(c)(3) equine-facilitated therapy center that promotes increase independence and resilience through the power of the horse. By creating space for healthy relationships between horses and humans, we help students learn life skills in a safe, inclusive environment. We don’t want to just touch lives, we want to change lives.

Please ensure email is valid as all scheduling is communicated via email.
Sign in to Google to save your progress. Learn more
Email *
Please note that due to the COVID-19 pandemic we had to put a majority of our clients on hold. We are slowly getting back to full capacity but have collected a large number of applications. There is currently a substantial waitlist to start equine services of any type, most likely a wait of over a year for our Adaptive Riding and Equine Facilitated Learning programs. Thank you for your patience!
Participant Name (first and last) *
If using legal name, you can include preferred name in parentheses
Date of Birth *
Parent/Guardian Name *
Enter 'self' if the applicant is over 18 and is their own legal guardian
Street Address *
City, State *
Zip code *
Primary Phone Number *
Preferably a cell phone number as we do most communication through texting
Emergency Contact Name *
Who should we call in case of emergency and primary contact is not available?
Emergency Contact Phone Number *
Caregiver Name (if applicable) *
Answer N/A if this is yourself or the above parent/guardian - Who will typically be bringing the participant so that we can contact them with any last minute information about session?
Caregiver Phone Number (if applicable) *
Gender *
The participant identifies as:
This helps give us an idea what horses the participant can work with if riding.
Clear selection
This helps give us an idea what horses the participant can work with. Please note we have a maximum weight policy of 250 pounds for riding.
Clear selection
Race *
Service Affiliation *
Service Status *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Healing with Horses ranch. Report Abuse