THR - Tecate Horse Rescue

Section 1 of 3: Participant and Emergency Contact Information

Participant Information

Full Name *

Date of Birth *

Gender *

Male Female Others Prefer not to say

Phone Number *

Email Address *

Home Address

Street *

City *

State *

ZIP Code *

EMERGENCY CONTACT

Name *

Relationship *

Phone Number *

Section 3 of 3: Session Preferences, Consent and Signature

SESSION PREFERENCES

Preferred session days/times *

Are you interested in *

Individual therapy Group sessions Family sessions

CONSENT & WAIVERS

Please review and sign below *

I understand that equine-assisted therapy involves interaction with live animals and outdoor environments. I assume all risks involved. I release Tecate Horse Rescue and its staff/volunteers from any liability resulting from participation. I grant permission to be contacted and, if consented separately, photographed for program purposes.

Signature (Parent/Guardian if under 18) *

Date *

The Herd That Heals Wellness Weekend Retreat

The Herd That Heals Experience

Tecate Horse Rescue - Equine-Assisted Therapy Registration