BBEAP Registration | Peaceful Pastures

Peaceful Pastures Biblically-based

Equine Assisted Learning Programs

Registration Form

Participant Information

Full Name

Birthday

Month

Day

Year

Gender

Phone

Address

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.

Signature

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Date