Client/Participant's Personal Details

Please note, if you are enquiring for more than one child, you will have to complete a separate form for each child.

Full Name (Client/Participant) *

Preferred First Name (Client/Participant)

Date of Birth (Client/Participant) *

Full Name (Parent/Support Coordinator/Guardian etc.)

Contact Phone Number (Client/Parent/Support Coordinator/Guardian etc.) *

Expression of Interest - Horse Wisdom Program

Email Address (For communicating with client/representative) *

Secondary Email

Client Home Address:

Contact Address * (for administrative and billing purposes)

I am completing this form on behalf of the Participant

Your relationship to the Participant

Name of Participant's Representative (person filling out form)

Phone number of Representative

Email Address of Representative

About Me (the Client/Participant)

Providing the following information helps us understand the reasons for you wanting to take part in this program.
None of the questions are compulsory, however they will assist us to understand your child's needs better leading up to, during and after the workshops.

Reasons for ParticipationBriefly state reasons for wanting to participate in the Horse Wisdom Program.

Is the participant NDIS funded? *

If the participant is NDIS funded, please specify how the funds are managed:

Self-managedPlan-managedAgency-managed

Name of plan management company (if applicable)

Describe why you think the Horse Wisdom Program will be of benefit:

How did you hear about/find our practice?

Event Details - Setting Expectations

Thank you for taking the time to complete this survey to express your interest in having your child partcipate in our Saturday morning Equine-Assisted Learning program.

To set realistic expectations, we need to mention the implications of this program running through the middle of Winter. Horses don't love being involved in our activities when it's freezing, windy and torrentially wet. The Winter Horse Wisdom Program may be cancelled at short notice if weather conditions are severe (does not include light rain or wind). We will keep you updated in the week leading up to the session to indicate whether it will run for that fortnight and advise you of any reschedule options.

Once you have completed this form, your details will be held securely on file and we will email you regarding availability of a place as numbers are set to a maximum of 8.

There will be a waiting list and we will work with you to ensure your child is able to partipate in the program at an alternate date and time.

Payment of 50% of the full amount (AU$345) for the course will be required as a non-refundable deposit to secure the offer of a place. The remaining 50% (AU$345) will be required 48 hours prior to course commencement to avoid your place being offered to someone on the waiting list.

Details of our cancellation policy can be found on the website (hyperlink).

Many thanks

Bek and Sarah

Adelaide Art/Equine Therapy and Horsewise of Hahndorf

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