Camper Information:
Parent/Guardian Information
Health and Diagnosis:
Please tell us about the camper's current health, challenges, and needs in the appropriate sections below. Please also make note of any adaptations the camper would require to thrive at camp.
By typing your name in the box below you indicate that the above information is correct to the best of your knowledge. You also understand that participation in any Heartland Therapeutic Riding program also requires completion of our Medical Statement form which must be signed by a physician indicating medical approval of participation. (Parent or Guardian signature required if participant is under 18)