Program Inquiry General Information Participant * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * School/Place of Employment * I'm interested in... * Please read the following descriptions and select your desired program below. —EQUINE-ASSISTED LEARNING: Our EAL programs are designed for individuals, groups, and the classroom setting to help people of all ages develop tools to enhance education, personal development and leadership. —THERAPEUTIC HORSEMANSHIP: Connecting with horses through groundwork and riding supports all facets of well-being and seeks to empower participants to gain equestrian skills while strengthening physical, mental, and emotional health. —EQUINE-ASSISTED THERAPY: Incorporating the horse and nature into therapy sessions is a unique opportunity for meeting individual treatment goals and improving overall health and well-being. Equine-Assisted Learning Therapeutic Horsemanship Equine-Assisted Therapy Multiple Programs How did you hear about Hickory Top Farm? * Horse Experience Has the participant had prior experience around horses? * Yes No What interests you most about working with horses? * Goals What are the participant’s primary goals for equine-assisted services? * Check all that apply. Physical strength and coordination Confidence and self-esteem Social skills and interaction Self-awareness & emotional regulation Managing anxiety Additional goals Additional Information & Comments Please share any additional thoughts. Thank you for your interest in Hickory Top Farm.
