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Participant Information
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Email
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Your email
PARTICIPANT'S First Name
*
Your answer
Last Name
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Your answer
Birth Date
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MM
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DD
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YYYY
Gender
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Your answer
TEXT Capable Phone
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(required for receiving notice about cancellations due to weather)
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Alternate Phone
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Street Address
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City/State/ZIP
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Your answer
County of Residence
*
Your answer
Referral Source
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Your answer
Which service(s) are you seeking?
*
Veterans and First Responders Horsemanship Group NOTE: This is a ground-based class only. No riding is involved.
Veterans and First Responders Equine-Assisted Therapy Group NOTE: This is a ground-based class only. No riding is involved.
Required
Military Service or First Responder Experience
Your answer
Years of Service
Your answer
Injuries as a result of Service
Your answer
Current Employer
*
Your answer
Current Treatments or Therapies You Want Us to Know About
Your answer
Please describe your goals for participation in Veterans Group:
*
Your answer
What do you feel is important for the group facilitator to know about you?
*
Your answer
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