Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Program for which you seek financial aid? *

Horse Budz Group

Teen Empowerment Group

Funds are limited and submission of an application does not guarantee a financial aid award. Anyone being awarded financial aid or a scholarship will be expected to pay an affordable co-pay as well as sign a contract committing to attending the program and arriving on time. *

I have read and agree to the above terms & conditions.

Child's Name

First Name

Last Name

Date of Birth

MM

DD

YYYY