HOH Military/First Responders Initial Questionnaire

Military/First Responder Initial Questionnaire
Heroes on Horseback (HOH) is an organization that provides empowerment and healing through the power of the horse. Our organization enriches our community and the lives of individuals with special needs by providing equine assisted activities and therapy in an effective and compassionate environment.

Our Military/First Responder program focuses on members of the Armed Services, active, honorably discharged or retired, and first responders active and retired. These populations can benefit physically and/or emotionally from equine therapies and learning. Each session provides challenging and life changing experiences tailored to individual participant capabilities.

Equine-assisted therapies are not activities for everyone and as such each applicant will be assessed by the HOH staff for suitability. HOH is a PATH, Intl. (Professional Association of Therapeutic Horsemanship, Intl.) program and follows the PATH guideline in all activities.

Class Date and Time: Certain weekday mornings.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email
example@example.com
Are You Ambulatory?*

YesNo
What Is Your Weight In lbs?*
Tell Us About Your Equine Experience (if any):
Last Time You Had Experience With A Horse (Leave Blank If None)

MonthDayYear
Date
Frequency?*

Once Per MonthOnce Per WeekMultiple Times Per WeekNo Experience
Do you have experience with?*

GroomingTackingGround WorkRidingNone
Tell Us About Your Personal Goals With Equine Therapy:
Why are you interested In equine-assisted therapies and learning?*
What do you hope to gain from equine-assisted therapies and learning?*
What do you expect from your mentor?*
Are you willing to take direction and follow Instructions as given by your mentor?*

YesNo
Do you have any questions for us?
HOH Safety Policy

Safety of our participants, staff, volunteers, and horses is paramount. Behavior of any kind, no matter the cause or reason, that is deemed to be unsafe, potentially unsafe, or disruptive by the HOH Program Director (or a designated mentor) while participating in an HOH sponsored activity will be cause for immediate dismissal.

Bags and backpacks must be left in your vehicle. No weapons of any kind (firearms, explosives, combat/long blade knives, etc.) are permitted on HOH property or at HOH sponsored events. HOH is a non-smoking facility.

The only drugs permitted on HOH property or at HOH sponsored events are those prescribed by a licensed physician to the HOH Veteran participant.
I have read, understand and agree to comply with the HOH Safety Policy as described in this document.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Enter the message as it's shown*
Should be Empty:

Military/First Responder Initial Questionnaire