Host Application

Fields marked with an * are required.

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

I understand the requirements for hosting an Equine First Aid Clinic found here: https://equinefirstaidclinics.com/hosting-a-clinic*

Yes

What clinic are you interested in hosting?*

Equine First Aid Fundamentals 1/2 Day ClinicEquine Emergency First Aid Clinic (most popular/prerequisite for Advanced Clinic)Advanced Equine First Aid

When would you like to Host a Clinic?*

Date

Where will the clinic be held? (Boarding Facility, Equine Rescue, Private Home, etc.)*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Website / Social Media (type n/a if not applicable)*

How many "patient" horses do you have available?*

What type of area with electricity do you have available for the PowerPoint portion of the clinic? Please describe.*

What type of area do you have available for the hands-on portion of the clinic? Please describe.*

Do you have a bathroom facility available for students?*

Do you already have people ready to enroll in an equine first aid clinic?*

YesNo

Are you willing to promote the clinic locally?*

YesNo

Give us an idea of how you will promote the clinic: riding clubs, website, Facebook page, local newspaper, tack store, feed supply, etc.*

Please select all that apply:*

"Patient" Horses AvailableArea with Shade to Work with HorsesCovered Area for Rain or Snow to Work with HorsesArea with Seating and ElectricityArea to Eat Lunch

Comments or anything you would like to share:

Please verify that you are human*