Welcome to Kingman's Healing Hooves Equine Assisted Therapy Programs and Horsemanship Teaching Facility
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Participant Intake Form
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Name
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First
Last
Email
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Age
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Phone number
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Choose One
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Home
Cell
Work
Best time to call
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Which program are you interested in?
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KHH Horsemanship Riding Academy
Equine Assisted Learning Programs
Equine Assisted Psychotherapy
Horsemanship 101 Summer Camp
School Out-Reach Programs
Special Olympics Equestrian Team
Sponsorship
Therapeutic Riding
Veteran's Program (Helping Veterans Find a Purpose)
Volunteer
List if more than one interest
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We do have a weight limit for the comfort of our horses. Please list height and weight.
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Employer or School
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Relationship to Participant
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Self
Parent
Caregiver
Teacher
Please list diagnosis if any
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Thank you for your interest in our programs and entrusting us with the importance of teaching safe horsemanship and Equine Assisted Activities and Therapies to your loved ones. Our instructors will be in touch with you shortly to schedule your lesson time. If there is a delay in contact, possible website issues, please follow up with a phone call to 928-279-7581
Thank you, and we look forward to meeting you.
Kassie Schuerr
Kingman's Healing Hooves Director
Does participant use any devices?
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Including wheelchair, cane, communication devices, etc.
Payment Choice
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Due to a current waiting list, in order to reserve your lesson time, all first time lessons are required to secure the time with a $15 non-refundable deposit, with remainder due at time of lesson. Due to unforeseen circumstances on the clients part, the lesson time may be rescheduled only one time, with a minimum of 6 hour notice. Please type in the "Payment Choice" box with either; cash, check or paypal and your full name. All deposits due one week before scheduled lesson.
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