2022 Crisis Session Application
Equine-Assisted Learning promotes mental, emotional, physical and social healing
Use this form only if you want to sign a child up for one on one therapy sessions

Crisis Sessions are for those who need immediate hope, understanding, guidance and support. Some examples that qualify for crisis sessions are:
*Can't seem to function well in daily activities
*Withdrawing from social activates
*Coming out of Pine Rest or similar residential program
*Struggling with grief from death of a friend or loved one



Requirements:
* Session participants must be age 5 to 18
* Parent or legal guardian must remain on site during the session time
* Completed liability form must be on file at the ranch prior to beginning session

Information:
* Submitting this application does not guarantee your child is accepted for the program.
* You will be contacted for days and times that are available
* Sessions are 60 minutes in length
* Session time will include grooming, helping with a chore, and equine-assisted learning activities
* Horseback riding is NOT a part of our equine-assisted activities

** A donation of $35/session is recommended **
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Email *
Contact Information for the primary parent/guardian
Parent or legal guardian first name *
This person will be the primary contact person
Parent or legal guardian last name *
Address: Street *
Address: City *
Address: State *
Address: Zip Code *
Phone number (xxx-xxx-xxxx) *
Best number to reach you
Secondary Parent/Guardian
Contact information for the secondary parent/guardian
First Name
Last Name
Street
City
State
Zip
Phone
Email
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