Participant Inquiry Form
Provide your details to inquire about participation and begin the intake process.
Participant
*
First Name
Last Name
Participant Birth Date
*
-
Month
-
Day
Year
Date
Participant Weight
*
Participant Disabilities (select all that apply)
*
Autism
ADD/ADHD
Cerebral Palsy
Down Syndrome
Physical Disability
Sight Impaired
Age Related
Hearing Impaired
PTSD
Oppositional Defiant
Meta-tropic Dysplasia
Tourettes
Epilepsy
Sensory Processing Disorder
No Disability
Other
Other disability not listed above
Is participant verbal
Yes
No
Limited
Please describe participant's level of mobility
Please describe any previous horse experience:
Program of Interest
*
Please Select
Adaptive Riding Lessons
Equine Assisted Learning
Veteran and First Responder Services
What goals would you like to see participant accomplish at Silver Lining Riding?
Who should we communicate with regarding scheduling and paperwork?
Participant
Parent/Guardian
Other Caregiver
Primary Contact
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does participant have any sensory limitations, triggers or fears we should know about?
How would you describe participant's ability to focus and follow simple directions?
Preferred Payment Method:
*
Please Select
Private Pay
ESA / ClassWallet
Please select your availability. Select all that apply
*
Weekday Mornings
Weekday Afternoons
Weekday Evenings
Saturday
How did you hear about Silver Lining Riding
Is there anything else you would like to share about your participant?
Book your participant and family barn tour:
Submit Inquiry
Should be Empty: