Session Request Form

The heart of the CPYR Session Program is to provide a safe place for children, families, and horses to experience the hope, healing, and encouragement of Jesus Christ.

CPYR serves all kids ages 6-18 by offering one-on-one mentorship sessions Monday through Thursday at the following times:

March - May

2:30-4:00pm and 4:00-5:30pm

June - August

9:30-11:00am, 11:00am-12:30pm, and 4:00-5:30pm

September - October

2:30-4:00pm and 4:00-5:30pm

Scheduling Day for October begins on September 15th at 9:00am.

We work diligently to ensure we can serve as many children and families as possible, so please complete this form anytime after the 15th at 9:00am if you are interested in getting involved with CPYR's Session Program. If we receive more requests than available spots, we will notify you and add you to our back-fill list for this month.

If you complete the Session Request Form before 9:00am, your session request will automatically get bumped to the bottom of our requests.

Your Name*

First NameLast Name

Your Email Address*

It works best to enter your email address we typically send email to.

Number of Children to Schedule*

Family Size for Database

Numeric Family Size for Conditional Logic

First Child's Name*

(First and last name)

First Child's Date of Birth*

Session program available for ages 6-18

Depreciated - Date of Birth 1*

Gender:

MaleFemale

Second Child's Name*

(First and last name)

Second Child's Date of Birth*

Session program available for ages 6-18

Depreciated - Date of Birth 2*

Gender

MaleFemale

Third Child's Name*

(First and last name)

Third Child's Date of Birth*

Session program available for ages 6-18

Depreciated - Date of Birth 3*

Gender

MaleFemale

Fourth Child's Name*

(First and last name)

Fourth Child's Date of Birth*

Session program available for ages 6-18

Depreciated - 4th Date of Birth *

Gender

MaleFemale

Fifth Child's Name*

(First and last name)

Fifth Child's Date of Birth*

Session program available for ages 6-18

Depreciated - Date of Birth 5*

Gender

MaleFemale

Sixth Child's Name*

(First and last name)

Sixth Child's Date of Birth*

Session program available for ages 6-18

Depreciated - Date of Birth 6*

Gender

MaleFemale

Seventh Child's Name*

(First and last name)

Seventh Child's Date of Birth*

Session program available for ages 6-18

Depreciated - Date of Birth 7*

Gender

MaleFemale

Eighth Child's Name*

(First and last name)

Eighth Child's Date of Birth*

Session program available for ages 6-18

Depreciated - Date of Birth 8*

Gender

MaleFemale

Ninth Child's Name*

(First and last name)

Ninth Child's Date of Birth*

Session program available for ages 6-18

Depreciated - Date of Birth 9*

Gender

MaleFemale

Tenth Child's Name*

(First and last name)

Tenth Child's Date of Birth*

Session program available for ages 6-18

Depreciated - Date of Birth 10*

Gender

MaleFemale

Would you like to share information about your family / child(ren) with their session leader(s):*

YesNo

Please share:

i.e. Divorce/Re-marriage, Single-Parent Home, Alcoholism, Physical/Sexual Abuse, Addiction, Death, Chronic Health Issues, Homelessness, Legal Guardianship Change, Foster Care, Adoption, Depression/Anxiety, Lack of Food/Financial Resources.

For liability purposes, I understand that a parent/guardian is required to stay on-site for the full 90-minutes of a session.

Adult's Name

(First and last name)

Phone #:*

Family Volunteering Opportunities

Our 1:00-2:30pm session slots have been set aside to be a time of family-centric volunteer activities. We invite you to join alongside our staff as a family unit, whether you're scheduled for sessions or placed on the waitlist. If you are interested in coming to CPYR for this opportunity, please check the box below.

We are interested in Family Volunteering at 1:00pm. Please send us more details!

Non-Horse Sessions

We have staff members who would be delighted to spend time with children and teens who are not directly involved with our horse program. If your child(ren) are interested in spending time with a mentor engaged in activities outside of our horse program, please indicate which child(ren) below.

Note: Please also include the child(ren)'s ages.

Schedule Availability

Using the calendars below, please select up to 10 days/times you are available for sessions. The more information you provide, the more likely it is that we will be able to schedule you. We typically schedule each child for 2 sessions per month.

Once you've submited your availablity, our Scheduling Team will contact you back to schedule your child(ren), taking these options into account. We plug in as many sessions as our team has availability for, but we often have more needs than we're able to fulfill. Thank you in advance for your patience & desire to be a part of God's ministry here at CPYR!

How many preferred dates would you like to provide?*

The more options you provide the more likely we are to be able to find a time that works.

Total Preferences Provided

First Preference *

Second Preference *

Third Preference *

Fourth Preference*

Fifth Preference*

Sixth Preference *

Seventh Preference*

Eighth Preference*

Ninth Preference *

Tenth Preference*

Please include any other details that might be helpful for our scheduling team (such as days/times that you are unavailable, vacation or time away, etc.)

Following Scheduling Day, the Scheduling Team will begin to fill sessions beginning with requests submitted at 9:00am, and continuing until all of our sessions are filled. This helps give every family the same opportunity to come for sessions. Those not initially scheduled are added to our backfill list and will be contacted throughout the month as sessions become available.

Preferences

If we are unable to schedule your family/group initially, you will be placed on our waitlist. Please indicate which types of session openings you would like to be notified about.*

Only Sessions Outside of School Hours (4:00-5:30pm)All Available Sessions

Are you new to the CPYR Session Program? (e.g. Never taken part in sessions before OR it's been a few years)

YesNo

Are you open to scheduling sessions at different times if there are not enough session leaders available to schedule all of your kids at once?*

YesNo

Would you like to receive your appointment reminders via text (default is email)?

NoYes

Cell Number for Text Reminders*

Please enter a valid phone number.

Network Provider for Cell Phone*

Usually Verizon, AT&T, or T-Mobile

Hidden Field, Value Selected for Appointment Reminders

Please verify that you are human*