Horse Camp Connections for All Abilities Registration Form

Herd Connections Summer Horse Camp for Mental Health Wellness Registration Form

Ages 11-14
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*

YearMonthDay
Date
Participant's Age*
Participant's Preferred Pronouns*

She/HerHe/HimThey/ThemOther
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)*
Phone Number (home)
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.
Participant's School (Fall 2025)*
Participant's Grade (Fall 2025)*
Is your Participant currently in counselling or therapy?*

YesNo
Has Participant attended Stable Connections Summer Camps before?*

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

YesNo
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?*

YesNo
If yes, please specify date of last known seizure and if stabilized with medication.
Does your Participant have any allergies?*

YesNo
If Yes, please list allergies.
Please indicate the particular challenges your Participant is facing:

Self-esteemRelationship issuesAssertiveness issuesCommunication issuesFearsStruggles with friendsFeeling isolated or lonelyFeeling disconnected from self or othersAnxietyTrouble sleepingDepressionAnger or frustrationIdentity strugglesStruggles with life adjustments or changes
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?*

YesNo
If Yes, please describe the required accommodations.
Does your Participant have any previous horse experience?*

YesNo
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?*

PoorFairGoodExcellent
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?*

PoorFairGoodExcellent
Please describe in more detail, and please give suggestions for successful strategies for handling those needs.
Does your Participant have any sensory concerns?*

YesNo
If Yes, please indicate their sensory needs, and give suggestions for successful strategies for handling those needs.
Is Participant a Stable Connections client?*

Current Stable Connections clientFormer Stable Connections clientClient at other therapy centerSibling of clientNone of the above
If current or former Stable Connections client, indicate therapist/instructor (check all that apply)*

Sarah-Michelle SenécalNathalie Van der ZaagAnita MathuOther
Is there anything else you feel would be helpful for us to know about your Participant?
Participant T-shirt Size

Youth X-SmallYouth SmallYouth MediumYouth LargeYouth X-LargeAdult X-SmallAdult SmallAdult MediumAdult LargeAdult X-Large
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). *

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Parent/Guardian Signature 2

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Herd Connections Summer Horse Camp for Mental Health Wellness Registration Form