New Client Application/Intake Form – Center Stage Athletics & Team CSFP Logo
  • Equine Assisted Coaching Questionnaire

    Thank you for taking the time to complete this form. Information provided will help me determine the best possible coaching and/or learning experience for you.

    PLEASE NOTE: If you are interested in family, other group coaching or team building, please contact me directly to discuss details. For individual coaching, please complete the information below. Please send an email to info@centerstageathleticscoaching.com for more information. 

  • Client Contact Information

    Please complete the below information for the CLIENT.



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  • If you are NOT the client, please complete the following information.

    If you are submitting on behalf of someone else, please complete the information below.
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  • Coaching Goals

    If you are completing this form as a parent/guardian, please feel free to express both your desire and your child's desires.



  • Horse Experience

    Please keep in mind that NO horse experience is required for Equine Assisted Coaching.

  • Legal Disclaimer

    The services provided by Withers and Wellness, a subsidiery of Center Stage Athletics, LLC, including Equine Assisted Coaching, are not intended to be a substitute for professional therapy, counseling, or medical treatment. Equine assisted coaching focuses on personal development, self-improvement, and enhancing life skills through interactions with horses. It is designed to offer clients unique insights and experiences for personal growth.

    Equine Assisted Coaching should not be construed as mental health therapy, psychological counseling, or any form of clinical treatment. If you are experiencing mental health issues or need medical advice, diagnosis, or treatment, please consult a licensed healthcare professional.

    By participating in equine assisted coaching sessions with Withers and Wellness, you acknowledge and agree that:

    1. Equine assisted coaching is a personal development tool and not a therapeutic intervention.
    2. You understand and accept that Withers and Wellness and its coaches are not licensed therapists or medical professionals.
    3. You are solely responsible for seeking appropriate professional medical or psychological advice, treatment, or diagnosis as needed.

    Additionally, please be aware that activities involving horses are inherently dangerous. Horses, as prey animals, can exhibit unpredictable behaviors such as bucking, rearing, kicking, and biting. These behaviors can result in serious injury or even death. By participating in equine assisted coaching, you acknowledge and accept the risks associated with working with horses.

    Withers and Wellness and its employees, contractors, and affiliates disclaim any and all liability for any adverse outcomes resulting from your participation in equine assisted coaching sessions. Your participation is voluntary, and you assume full responsibility for any risks associated with these activities.

    By engaging in equine assisted coaching with Withers and Wellness, you agree to release and hold harmless Withers and Wellness, its owners, employees, and affiliates from any claims, damages, or liabilities arising from your participation.

    If you have any questions or concerns about the nature of equine assisted coaching or this disclaimer, please contact us before participating in any sessions.

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