Waiting List Inquiry Form
Due to high demand, our weekly therapeutic horsemanship mounted and ground based programs currently have a waitlist and we are not accepting full applications at this time.If you would like to be contacted when an application becomes available, please complete the interest form below. Submitting this form does not guarantee placement in the program but allows us to reach out as openings become available.
Participant Name:
*
First and Last Name
Preferred name if different
Gender
*
Male
Female
DOB
*
Current Age
*
Height
*
Weight
*
Eligibility for mounted services requires that clients must be must be 175lbs or less. Clients needing moderate to maximum physical support must be 100lbs or less.
Address
*
Address
Street Address Line 2
City
State
Zip
Phone
*
Format: (000) 000-0000.
Email Address
*
example@example.com
What is your preferred method of contact?
*
Phone call
Text message
Email
Parent/Legal Guardian name, if a minor
First and Last Name
Parent/Legal Guardian phone
Format: (000) 000-0000.
Please list all diagnosis as it pertains to equine assisted services and the date of onset and give current health information and a brief health history as it pertains to equine assisted services.
*
Please provide us with pertinent health history information that may impact participation in activities provided by Wings of Hope.
Do you have a program preference?
*
Mounted (horseback riding)
Ground based (non mounted)
No preference
Has the participant participated in equine-assisted services before?
*
How did you hear about us?
*
Availability & Commitment
Wings of Hope operates Labor Day through Memorial Day. You will commit to the same day and time weekly. You must be able to make the weekly commitment and not miss more than 8 absences during the season in order to maintain your spot on the schedule.
My ideal day is
blank
. My preferred time is
blank
*
.
I am available
*
Monday
Tuesday
Wednesday
Thursday
I am available
*
10:00-12:00
12:30-3:00
3:30-4:30
5:00-6:00
6:30-7:30
To help us better understand your availability does the client participate in any of the following:
*
School (traditional in person)
Homeschool
Work (part time)
Work (full time)
Homemaker
Retired
Other
Participant, Parent/Legal Guardian Signature
*
Today's Date
*
/
Month
/
Day
Year
Date
Please note: This form is not an application for services. It simply allows us to keep your contact information on file so we can reach out when we are able to accept new applications.Our ability to open applications depends on movement through our current waiting list and ensuring our horses, staff, and volunteers have the capacity to provide safe, high-quality programming. Openings most often occur when current participants leave the program or when program capacity allows us to welcome additional participants.When space becomes available and we are able to accept new applications, we will contact families who have submitted this form with next steps.
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