Participant Form
William's Walk Therapeutic Riding and Cart-Driving and Hooves on the Ground Application
Name
First Name
Last Name
Relationship to Participant
Email
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
Participant Name
Participant Age/Height/Weight
Participant Grade and School
Participant Diagnosis
Does the participant have seizures?
Please Select
Yes
No
Does participant have trouble with ambulatory movement? If yes, what assistive devices are used?
If the participant uses a wheelchair, can the participant stand and pivot with assistance?
Which program are you interested in joining?
William's Walk Therapeutic Riding and Cart-Driving
Hooves on the Ground (Veterans, Active Duty Military, and First Responders)
How did you hear about The Right Path?
Please Select
Search Engine
Social Media
TV
Radio
Friend or Family
Please let us know why you want to participate in William's Walk Therapeutic Riding and Cart-Driving or Hooves on the Ground!
Submit
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