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. 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

Date

Participant's Preferred Pronouns

Other

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)

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.

Has Participant attended Stable Connections Summer Camps before?

Does your Participant have a formal diagnosis?

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 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 sensory concerns?

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?

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?

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.

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?

Is Participant a Stable Connections client?

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

Does your Participant have any allergies of dietary needs?

If Yes, please list allergies or dietary needs

Describe your Participant's comfort level around animals.

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

Horse Adventure Camp for Adults with Disabilities Registration Form