Horse Camp Connections for All Abilities Registration Form

Participant Details:

Please complete one sign up form per participant. Return to this page if you need to fill out forms for siblings.

Participants should be able to participate in large group activities. Participants should not be activley dangerous to self or others at this time to be able to participate in camp.

Stable Connections will coordinate with families prior to camp to determine the specific needs of participants.

Participant's Full Name

First NameLast Name

Participant's Preferred Name/Nickname

Participant's date of Birth

Date

Participant's Age

Participant's Preferred Pronouns

Other

Participant's Weight (note there is a 200lbs weight limit for the riding portion of camp)

Parent/Guardian Name 1 (Both parents/guardians must sign up and sign)

First NameLast Name

Parent/Guardian Name 2

First NameLast Name

Participant's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number (cell)

Format: (000) 000-0000.

Phone Number (home)

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Contact Name

First NameLast Name

Emergency Contact Relationship to Participant

Emergency Contact Phone Number

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

Participant's School (Fall 2025)

Participant's Grade (Fall 2025)

Is your Participant currently in counselling or therapy?

Has Participant attended Stable Connections Summer Camps before?

Will Participant's sibling(s) be attending camp either as participant(s) or volunteer(s)

If Yes, please list name(s) of all siblings who will be attending. NOTE - SEPARATE REGISTRATION FORMS ARE REQUIRED FOR ALL PARTICIPANTS

Does your Participant have a history of seizures?

If yes, please specify date of last known seizure and if stabilized with medication.

Does your Participant have any allergies?

If Yes, please list allergies.

Please indicate the particular challenges your Participant is facing:

List any known mental health diagnosis(es) for your Participant (list "None" if not applicable)

Briefly describe your Participant's physical ability/fitness level.

Does your Participant require any special accommodations?

If Yes, please describe the required accommodations.

Does your Participant have any previous horse experience?

If Yes, please describe.

Please describe your Participant's comfort level around horses and animals.

What do you hope your Participant gains from participating in Stable Connections' - Herd Connections Summer Horse Camp for Mental Health Wellness?

What are your Participant's strengths?

How would you describe your Participant's attention level?

Please describe in more detail, and please give suggestions for successful strategies for handling those needs.

How would you rate your Participant's ability to integrate into group activities?

Please describe in more detail, and please give suggestions for successful strategies for handling those needs.

Does your Participant have any sensory concerns?

If Yes, please indicate their sensory needs, and give suggestions for successful strategies for handling those needs.

Is Participant a Stable Connections client?

If current or former Stable Connections client, indicate therapist/instructor (check all that apply)

Other

Is there anything else you feel would be helpful for us to know about your Participant?

Participant T-shirt Size

How did you hear about us?

Please Specify

I hereby submit this application for the above named participant for Stable Connections 2025 Summer Camps. I give permission to Stable Connections to use/publish photographs and/or audio videos of my participant taken during camp for marketing or other corporate purposes. I further understand that participation in Stable Connections 2025 Summer Camps must be approved by Stable Connections Program Director and/or Therapists, and that I may be required to provide a 1:1 aide if my participant’s needs exceed the abilities of Stable Connections 2025 Summer Camps volunteers and staff as determined by Stable Connections. I further understand that camp fees are due upon my participant’s acceptance into Stable Connections 2025 Summer Camps.

Parent/Guardian Signature 1 (Both parents/ guardians MUST sign).

Parent/Guardian Signature 2

Herd Connections Summer Horse Camp for Mental Health Wellness Registration Form