Interest Form

Interest Form

Thank you for your interest in Hold Your Horses! Please complete this form to let us know how you'd like to get involved.
Please Note: As we fund a limited number of equine therapy sessions, we currently serve those who are actively participating in ongoing therapeutic care. This ensures continuity of care when the equine therapy package comes to an end.
Please indicate your area of interest for Hold Your Horses.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

CityState / Province

Postal / Zip Code
Email
example@example.com
How did you hear about Hold Your Horses?

Other
Equine Therapist Partner Interest
What is the name of your equine therapy practice?
Is the barn you partner with at a different address than your therapy practice office?
Location of your equine therapy practice

Street Address

Street Address Line 2

CityState

Zip Code
What model of equine psychotherapy are you certified in?
How long have you been practicing equine therapy?
Volunteer Interest
Where are you located?

Street Address

Street Address Line 2

CityState

Zip Code
Please share about any previous volunteer experience you have, including any special experience or skills (i.e. horse training, event planning, etc.)
Tell us about your interest in volunteering with Hold Your Horses.
Interested Participants

We're excited that you are interested in participating in equine therapy funded by Hold Your Horses! Please complete this section to help us better understand your child and determine a potential fit for our program.

Please Note: To ensure your child qualifies for participating in equine therapy funded by Hold Your Horses, you may be asked to provide necessary documentation at a later date. This interest form is not an application and does not constitute as any form of acceptance into any Hold Your Horses programs.
Age of child or teen interested in equine therapy
Age in years
Please briefly describe your child/teen's comfort level around horses (e.g. No experience, but open to new experiences; No experience, and feels unsure)
What do you or your child hope to gain from equine therapy?
I consent to allowing Hold Your Horses, Inc. to provide my or my child's obtained information to a partnering therapist for referral.
Note: By signing this form, you agree your electronic signature is legally binding and that all the information you entered into this form is accurate to the best of your knowledge.
Hold Your Horses, Inc. does not offer mental health emergency services. If you are experiencing a medical or mental health emergency, please contact 911 or go to your nearest emergency room.
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