Horse Camp Connections for All Abilities Registration Form

Horse Adventure Camp for Adults with Disabilities Registration Form

Ages 18+
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. Stable Connections staff and volunteers cannot assist with activities of daily living (ADLs) such as assisting with toileting, etc. for all participants. Please note: if your participant requires 1:1 support, it is offered on a first come first serve basis with limited availability.

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

First NameLast Name
Participant Preferred Name/Nickname
Participant's Age*
Participant's date of Birth*

YearMonthDay
Date
Participant's Preferred Pronouns*

She/HerHe/HimThey/ThemOther
Participant's Weight (NOTE: there is a 180lbs weight limit for the riding portion of camp)*
Parent/Guardian Name*

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.
Has Participant attended Stable Connections Summer Camps before?*

YesNo
Does your Participant have a formal diagnosis?*

YesNo
If Yes, please list diagnosis(es) (list "None" if not applicable)*
Describe any medical conditions, current medications, or pertinent medical information/ history (list "None" if not applicable)*
Indicate if your Participant needs assistance with any of the following: PLEASE NOTE Horse Camp Connections is 6 hours/day. We use the entire Ranch property, including walking up and down hills to the back of the property, dirt paths, etc. Participants requiring toileting assistance will be registered on a first come first served basis as we have limited resources to provide 1:1 support. Another option is if a sibling is able to attend camp as an aide (provided by family).**

Does NOT require any assistance with Activities of Daily Living (ADL)Requires assistance with eatingRequires assistance with toiletingRequires assistance with transferingRequires assistance walking distances, up/down hills, or on dirt/uneven surfacesRequires assistance communicating
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 sensory concerns?*

YesNo
If Yes, please indicate their sensory needs, and give suggestions for successful strategies for handling those needs.
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 sit still?*

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.
Please describe any mobility concerns and/or mobility devices your Participant uses. If not applicable please write "NONE".*
Please describe any communication concerns or challenges your Participant has and any communication devices your Participant uses. If not applicable please write "NONE".*
What goals are you hoping to target for the Participant during camp? (i.e., fine motor skills, social skills, postural control, life skills etc.)*
What are your Participant's strengths?*
Does your Participant participate in any therapies?*

Occupational TherapyPhysiotherapySpeech Language TherapyAdaptive RidingMental Health and ResilienceOtherNone
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 MathuMelisa JongsmaFloriane VermiereCristabel NettCarla BergenHayley EdwardsOther
Does your Participant have any allergies of dietary needs?*

YesNo
If Yes, please list allergies or dietary needs
Describe your Participant's comfort level around animals.*
Participant T-shirt Size

Adult X-SmallAdult SmallAdult MediumAdult LargeAdult X-LargeAdult 2X-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*
Should be Empty:

Horse Adventure Camp for Adults with Disabilities Registration Form