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Peaceful Pastures Biblically-based
Equine Assisted Learning Programs
Registration Form
Participant Information
Full Name
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Birthday
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Month
Month
Day
Year
Gender
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Phone
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Address
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Email
*
Emergency contact name, number, and relationship.
*
Please list any medical conditions and/or allergies. (this includes environmental and food)
Does you have any prior experiences with horses?
Do you authorize Peaceful Pastures to use and reproduce any and all photographs and adiovisual material taken of the participant and family members while in individual and/or group sessions for use in the promotion of Peaceful Pastures.
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Date
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