Programs Form Please fill out the form below and a member of our Program staff will be in touch. PROFILE INFORMATION Client Name * First Name Last Name Preferred Name (if different) First Name Last Name Age * Height (feet) * 2 3 4 5 6 7 Height (inches) * 1 2 3 4 5 6 7 8 9 10 11 Weight (in pounds) * Preferred Pronouns * She/Her/Hers He/Him/His They/Them/Theirs My pronouns aren't listed Prefer not to say Parent/Guardian Name * First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country QUESTIONNAIRE Tell us more about your interest in Equine-Assisted Services: * Do you have a diagnosis/disability you would be open to share with us at this time? * Select Program * Please choose the program you are interested in. Adaptive Riding - Mounted Horsemanship (Groundwork) Occupational Therapy Equine-Assisted Learning Group (Organizations Only-Not for Individuals) Frontline Heroes Group (Organizations Only-Not for Individuals) I'm not sure, I would like to learn more about the programs and services offered at High Horses. Which type of appointment would you prefer? * Group (up to 3 individuals) Individual/Private Either Which payment option will you be using? * Pay out of pocket I am a client of a third-party payer (Lincoln Street, HCRS, UVS, etc.) I'm unsure, would like more information Please select all days you are available for sessions/lessons: Monday Tuesday Wednesday Thursday Friday Please select preferred time of day for your session/lesson: 9:30 AM - 12:30 PM 1 PM - 3:30 PM 4:30 PM - 5:30 PM Is there anything else you would like us to know? (comments, questions, or additional information) Thank you for contacting High Horses. A staff member will respond to your inquiry as soon as possible. If you have any additional questions, please contact us at Hello@HighHorses.org or call (802) 763-3280.