Sign-Up Form for Great Strides (Equine Therapy Program)
Please complete this form if you are interested in enrolling in Great Strides. Our office will contact you about next steps in the registration process.
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Caregiver Name *
Caregiver Email *
Caregiver Phone Number *
Child's Full Name *
Child's Preferred Name (If different from full name)
Child's Gender *
Child's Date of Birth *
Are you currently in, or have you received in the past, services from Spirit Reins? *
Reason for seeking services *
What is your availability for group therapy? Please select all that apply. *
My child is... *
My child is... *
Would you like to be added to the Spirit Reins newsletter to stay up to date on programming?
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