Participant Application ← BackThank you for your response. ✨ Name(required) Relationship to participant(required) Email(required) Phone Number(required) Address/City/State/Zip(required) Participant Name(required) Participant Age/Height/Weight(required) Participant Grade and School? Participant Diagnosis(required) Seizures?(required) Yes No Does participant have trouble with ambulatory movement? If YES, what assistive devices are used?(required) If Wheel Chair- Can person stand and pivot with assistance?(required) How did you hear about us? Search Engine Social Media TV Radio Friend or Family Which program are you interested in?(required) William's Walk Therapeutic Riding and Cart-Driving Hooves on the Ground: A Restorative Experience for Veterans Tell us why you want to participate in the program(required) SendSubmitting form We will review the submitted application and contact you with availability and further details. Thank you for your interest! Δ
