Programs Form Please fill out the form below and a member of our Program staff will be in touch. PROFILE INFORMATION Client Name * First Name Last Name Preferred Name (if different) First Name Last Name Age * Height (in feet & inches) * Weight (in pounds) * Preferred Pronouns * She/Her/Hers He/Him/His They/Them/Theirs My pronouns aren't listed Prefer not to say Parent/Gaurdian Name * First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country QUESTIONNAIRE Tell us more about your interest in Equine-Assisted Services: * Do you have a diagnosis/disability you would be open to share with us at this time? * Select Program * Please choose the program you are interested in. Adaptive Riding - Mounted Horsemanship (Groundwork) Occupational Therapy Physical Therapy Counseling Equine-Assisted Learning Group (Organizations Only-Not for Individuals) Frontline Heroes Group (Organizations Only-Not for Individuals) I'm not sure, I would like to learn more about the programs and services offered at High Horses. Would you like more information about payment options or financial assistance? * Yes No Please select all days you are available for sessions/lessons: Monday Tuesday Wednesday Thursday Friday Please select preferred time of day for your session/lesson: 9:30 AM - 12 PM 12 PM - 3 PM 3 PM - 5 PM Is there anything else you would like us to know? (comments, questions, or additional information) Thank you for contacting High Horses. A staff member will respond to your inquiry as soon as possible. If you have any additional questions, please contact us at Hello@HighHorses.org or call (802) 763-3280.