New Student Intake Form
AHEAD With Horses Inc is a non-profit, developmental therapeutic riding program that specializes in children (12 and under) with multiple and severe disabilities, including autism. Our program uses vaulting, so we use a different type of saddle than most and have the students complete different exercises while on the horse. Our services are regularly scheduled on the half hour. Most clients ride twice per month.

Our schedule is currently full, and we have a waiting list. Our main facility is in Shadow Hills where we see students on Tuesday, Wednesday, and Friday afternoons as well as all day on Saturdays. We also have a mobile program in Brentwood that is only on Thursday afternoons.

If you have any additional questions about the program, price, etc., you can call the office at (818) 767 – 6373 or email us at info@awhla.org.

Please answer the following questions so we can determine the best way to meet your child's needs and you will be added to our wait list; you will be contacted when we have a possible spot available.
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Email *
Student Name *
Your First Name *
Your Last Name *
Primary Phone Number *
Is this a Cell Phone? *
Required
Secondary Phone Number
Is this a Cell Phone?
Street Address *
City *
Zip Code *
Student's Date of Birth *
MM
/
DD
/
YYYY
Child's diagnosis/Issues? *
Student's Weight (Estimate is fine) *
Student's Height *
Please give us some information about your child *
Yes
No
Can they walk?
Do they talk?
Can they sit up alone?
Can they hold their head up?
Are they blind/sight impaired?
Are they deaf/hearing impaired?
Please tell us about any assisted devices your child uses (wheelchair, walker, hearing aids, etc.)
Please tell us about any behavioral issues your child has and successful management strategies you use
Which location are you interested in? *
Required
What days are you available? *
Required
What is the earliest time of day you are available? (Currently lessons are in the afternoon on weekdays and 9-2 on Saturdays.) *
Time
:
Do you plan to use Regional Center Funding? *
Which Regional Center services your child?
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Is there any other information you would like to share?
May we add you to our email list while you wait for an opening? *
Thank you for completing the intake form; we will contact you as soon as we have an appropriate opening
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