EmailMe Form - Enrollment Application

Name
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Date of birth
Guardians Name
Phone
### - ### - ####
Email
Situation
Please explain why this child would benefit from this program? Please be ad detailed as possible
Estimated annual income
(to qualify on this basis pay check stubs or tax return will be need to be reviewed with application. )
Medical/Special Needs
Transportation available to and from the facility?
YES
NO
Allergies to animals:
YES
NO
Has participant ever been exposed to a horse?
YES
NO
Does participant have any behavioral problem?
Any other information that would help us determine if participant is eligible for our program?