Expression of Interest Form

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For applicants under 18yo, this form must be completed by a parent / legal guardian. By submitting this form on behalf of an applicant under 18yo, you are accepting the terms of the program and the program waiver on their behalf.

Email *

GENERAL INFORMATION

Sessions are all private sessions - just the student, the Mentor and the herd.

No experience with or knowledge of horses is required. All activities are on the ground – no horse riding is involved.

Completing this form does not guarantee you a place in a program or commit you to a program in any way.

Once you've submitted your form we'll be in touch to arrange for you to visit the sanctuary and meet your Program Mentor.

Where the Student is a Child: Please note that parents are required to stay on site while their child is in their program sessions but they will not be able to stay with the student during their program sessions for safety and privacy reasons.

Where the Student is an NDIS Client: If the student is an NDIS client and the carer will be bringing the student to their program sessions, the carer will not be able to stay with the student during their sessions for safety and privacy reasons. Our programs are not suitable for clients that need a high level of support or supervision from a carer.

Are you completing this form for yourself? *

Yes

No, I am the student's parent/legal guardian

Student's Name *

Your Name (if you are not the Student)

Contact Phone Number *

Which program are you interested in? *

Go Remarkable Program (for girls aged 14-19yo)

Recovery & Discovery Program (for women)

Young Veterans & First Responders Program

Required

Please tell us a little bit about you (or your child), why you are seeking support through this type of program (no specific details are required, just an overview) and what you are hoping to gain from the program. This information is held in strict confidence - only the program coordinator and mentor have access to your answers. *

Are you able to pay for your program or do you require a scholarship? *

I am able to pay for the program myself ($80 per session)

I will be using NDIS Funding for the program

I will need to apply for a full scholarship

I will need to apply for a part scholarship but can contribute to my program cost

Required

If you will be applying for a part scholarship, how much per session will you be contributing? *

A copy of your responses will be emailed to the address you provided.

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