Child Profile & Preferences

This intake form helps us get to know your child, their needs, and goals so we can provide the safest and most supportive experience possible in our equine program. Please answer as thoroughly as you feel comfortable—your input helps us tailor each session to best support your child.

Please only fill out this form when asked to by one of our team members.

Parent's Information

Parent's First name

Parent's Last name

Parent's Email

Parent's Phone

Emergency Contact (other than a parent)

Child's Information

Child's First Name

Child's Last Name

Birthday

Month

Day

Year

Would you be open to your child riding in the future, if they feel ready and it is a good fit for them?

Yes

Unsure

Child's Medical Information

Diagnoses (if applicable)

Physical Limitations

Allergies

Sensory Sensitivities

Behavior Information

Triggers

Calming Strategies

Communication Style or Needs

Attention Span or Needs

Comfort Level and/or Experience with Animals

Safety Needs (examples: aggression or elopement)

Goals for the Program

Short Term Goals (examples: express wants/needs or try new activities)

Long Term Goals (examples: confidence building and emotional regulation)

Additional Information

Additional information you’d like us to be aware of?