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.
Email address *
Participant Name *
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Date of Birth *
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Parent/Guardian Name *
Enter self if the applicant is over 18 and is their own legal guardian
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Street Address *
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City, State *
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Zip code *
Your answer
Primary Phone Number *
Your answer
Emergency Contact Name *
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 *
Your answer
Caregiver Name (if applicable) *
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?
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Caregiver Phone Number (if applicable) *
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Gender *
I identify as:
Race *
Service Affiliation *
Service Status *
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