VE Mentorship Intake Form

Vitality Equine Mentorship

GETTING TO KNOW YOUR LEARNING OUTCOMES
Personal Information
Name *

First Name Last Name
Preferred Gender Pronouns
Phone Number
Please enter a valid phone number.
Email *
example@example.com
Preferred method of contact *

Phone call Text Email
Professional Information
How are you affliated in the equine industry? *

Equine Bodyworker Veterinarian Chiropractor Physiotherapist Animal Health Technologist Trainer Horse Owner Horse Competitor Energy Worker Other
Please elaborate on your personal and professional equine experience (certifications, courses, experiences...etc) *
Learning Outcomes
What is your primary learning outcome for your mentorship experience with Vitality Equine? (i.e. do you want to practice evaluations, massage, energy work, business, marketing, anatomy...you get to decide!) *
What is your secondary learning outcome for your mentorship experience with Vitality Equine? (i.e. do you want to practice evaluations, massage, energy work, business, marketing, anatomy...you get to decide!) *
What are your equine related goals (personal and/or professional) for the next year? What about for the next five years? What do you want to be able to do? Who do you want to work with? *
What are you most afraid or nervous about when it comes to your equine practice? *
Anything else you want me to know. Feel free to share below!
Mentorship Experience
What kind of mentorship experience would you prefer? *

In-person Online
If you chose in-person, are you within one hour of Calgary?

Yes No
If you chose in-person, where are you located? (Airdrie, Springbank..etc?) This gives me a better idea of where to choose our mentorship destination!
Waiver
I understand that equine massage therapy educational services offered by Vitality Equine are never a replacement for a proper foundational course in equine massage therapy. These mentorship experiences are intended to supplement existing knowledge. I understand that the Vitality Equine practitioner will not diagnose conditions, attempt any adjustments/musculoskeletal manipulations or prescribe medications, nutraceuticals or supplements for horses. I acknowledge that muscle releases may result in underlying muscle mechanisms being exposed that were previously masked through compensatory movements.

I understand that I have 30 days to pay my invoice before a 15% late fee incurs. I understand that I can pay my invoice via e-transfer, credit card (Mastercard or Visa), cash or cheque.

By signing this document I acknowledge that I have read and understand it and all of its provisions and I am signing voluntarily. I do hereby waive and release Vitality Equine from all liability, past, present and future.
Signature *

Clear
Thank you
Thanks for taking the time to fill out this initial intake form. This helps me develop and curate an intentional mentorship experience for you. I will review your answers, and then get back to you with a formatted program for our mentorship day together. This program will include how you should prepare and where we will meet up!

Love and light,

Brigitte
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Vitality Equine Mentorship

Personal Information

Professional Information

Learning Outcomes

Mentorship Experience

Waiver

Thank you