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Kind Minds - Horse 'N Hound Stables Equine Program
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* Indicates required question
Email
*
Your email
First and Last Name of Participant
*
Your answer
Date of Birth of Participant
*
MM
/
DD
/
YYYY
Participants Address (unit/home# & street, city, province, postal code)
*
Your answer
Equine Therapy Season
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Fall 2022
Winter/Spring 2023
Both
Required
My preferred time slot for the above selected season(s) is:
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Wednesday's 5:30-7:00pm
Saturday's 10:00-11:30am
I am available for both time slots
First and Last Name of Parent/Guardian
*
Your answer
Parent/Guardian Email
*
Your answer
Parent/Guardian Phone Number (XXX-XXX-XXXX)
*
Your answer
Physical Limitations of Participant or Physical Accommodations Required
*
Your answer
Intellectual Limitations of Participant or Intellectual Accommodations Required
*
Your answer
Aids for Daily Living (such as braces, supports, communication aids, etc.)
*
Your answer
I understand that Kind Minds is not liable for any personal injury or damage to personal property
*
Yes
I grant Kind Minds permission to take my participants photograph, a video, and/or quoted statement from my participant for the sole purpose of social media advertisement and program promotion
*
Yes
No
What method do you intend to pay the Equine Program fee of $500.00 per season?
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Cash
Cheque
ETransfer
Other:
By Typing my name below, as the parent/guardian for the above mentioned participant, I verify this electronic signature.
*
Your answer
Upon completion of this form I understand that I will be sent a waiver from Horse 'N Hound Stables which I must complete and send back to KindMinds20@gmail.com prior to my participant engaging in the equine program.
*
Yes
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