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 *
Secondary Email Address
Please Note: There is currently a substantial waitlist to start equine services of any type.  It may take as long along as a 12 months depending on your available as session times become available. Thank you for your patience!
Participant Name (first and last) *
If using legal name, you can include preferred name in parentheses
Date of Birth *
MM
/
DD
/
YYYY
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. Please format phone as (000)000-0000
Secondary Phone Number
Complete field only if applicable. Please format phone as (000)000-0000
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)
Caregiver Email (if applicable)
Gender *
The participant identifies as:
Height
This helps give us an idea what horses the participant can work with if riding.
Weight
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.
Race *
Service Affiliation *
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