Warrior Herd Application

Registration & Wait List for Veterans, members of the Armed Forces and First Responders

Due to the generosity of our supporters and sponsors, needs-based funding is available.

Please complete the application below for consideration into the Warrior Herd program. You will be notified of application acceptance or Wait List status, or if additional information is needed. Thank you.

PARTICIPANT CONTACT INFORMATION

Participant Name

First Name

Last Name

Mobile Phone

(###)

###

####

Email Address

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

COUNTY of Residence

Applicant's Name

(if application completed by someone other than the Participant)

First Name

Last Name

Relation to Participant

Applicant's Mobile Phone

(###)

###

####

Applicant's Email Address

PARTICIPANT'S INTERESTS & BACKGROUND

Please select the Warrior Herd service that you are interested in?

Equine-Assisted Psychotherapy -- Group

Equine-Assisted Psychotherapy -- Individual

Equine-Assisted Wellness (Non-Therapy) - Family

Equine-Assisted Wellness (Non-Therapy) - Group

Is there a need for funding?

What do you/the Veteran hope to gain from participating?

Are you/the Veteran currently working with a mental health professional, with the VA or privately? Has a therapist been seen in the past? If yes, when and for how long? Is there a mental health diagnosis?

Please describe briefly.

Please describe if there are any physical challenges or limitations.

What was your/the Veteran's MOS?

Throughout military service, how many deployments have there been?

If you can, please share information about when deployment(s) started and ended.

Will you/the Veteran be able to provide us a copy of your/their DD214 upon request?

How did you hear about Warrior Herd or Project Horse?

PROGRAM GUIDELINES & FACILITY RULES

- No smoking or vaping permitted anywhere on our grounds. - All visits and sessions are by appointment only and must be scheduled in advance. Project Horse is not open to the public. - Weapons, of any kind, are never permitted at our facility or anywhere on farm grounds. - An individual needs to have medical and psychiatric stabilization in order to participate in Warrior Herd services. - No active substance use is permitted while at Project Horse, unless authorized by a treating physician. If you are presumed under the influence, you will be asked to leave. - For anyone diagnosed with a substance use disorder, a period of abstinence must occur before participating in Warrior Herd. The preferred period is 6 or more months. - For Veterans seeing other mental health care providers, a Release of Information is preferred so that we may collaborate on shared treatment goals.

By submitting this application, I hereby acknowledge that I have read, understood and agree to the Program Guidelines & Facility Rules outlined above.

Warrior Herd Application

Registration & Wait List for Veterans, members of the Armed Forces and First Responders

Project Horse Inc. (in Colorado)

CLIENT SERVICES & FACILITY

ADMINISTRATIVE OFFICE

Project Horse under the Arc of Loudoun (in Virginia)