Registration

Does the student currently have any conditions or limitations that might impair his/her physical mobility or compromise his/her ability to remain alert and thinking while engaged in equine-facilitated activities? *

Yes

No

Does the student have any food or insect bite allergies? *

Yes

No

Does the student currently have any medical conditions that need the attention of program staff (i.e. inhalers, medications, etc.)? *

Yes

No

Student

Personal Information

Medical/Psychological Information