202 TRP New Participant Inquiry Form
Thank you for your interest in therapeutic/adaptive riding and horsemanship at Haku Baldwin Center.

Submit this form to start your inquiry. Our Program Director will follow up to guide you through the application process. Please note that we do have a waiting list for services — we encourage those interested to reach out as soon as possible.

Should you have any questions after submitting the form, contact chrissy@hakubaldwincenter.org
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Email *
PARENT/GUARDIAN NAME (First & Last) *
PHONE NUMBER *
RELATIONSHIP TO CHILD *
CHILD'S NAME (First & Last) *
CHILD'S DATE OF BIRTH  *
AGE *
PRIMARY DIAGNOSIS *
SECONDARY DIAGNOSES (if any) *
MAIN GOAL: What is the primary reason for applying for services? *
I understand that there is a waiting list for this program, and that a formal application form w/ physician's referral needs to be submitted in order to apply. *
Required
Is there anything else you would like us to know about your child? Any questions or concerns about your child's ability to participate in therapeutic riding and horsemanship lessons? *
A copy of your responses will be emailed to the address you provided.
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