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.
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Email address
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Your email
Participant Name
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Your answer
Date of Birth
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Parent/Guardian Name
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Enter self if the applicant is over 18 and is their own legal guardian
Your answer
Street Address
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Your answer
City, State
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Your answer
Zip code
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Your answer
Primary Phone Number
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Your answer
Emergency Contact Name
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Who should we call if you get hurt or if you are in a panic because your child is hurt?
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Emergency Contact Phone Number
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Your answer
Caregiver Name (if applicable)
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Answer N/A if this is yourself or the above parent/gaurdian - Who will typically be bringing the participant so that we can contact them with any last minute information about session?
Your answer
Caregiver Phone Number (if applicable)
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Your answer
Gender
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I identify as:
Female
Male
Other:
Race
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Caucasian
Black or African American
Asian
Native American
Hispanic
Latino
multi or bi racial
Other:
Service Affiliation
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Not Applicable
Army
Marines
Navy
Air Force
Coast Guard
Police
Fire Fighter
Family Member
Other:
Service Status
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Active Duty
Retired
Reserve
Veteran
N/A
Other:
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