Pre-Survey for Participants
(or parents/guardians of children or teen participants)

Thank you for registering!

The information you provide in this survey will be kept strictly confidential and will only be used by Project Horse staff to ensure we are best able to meet participant needs. Please be as accurate and thorough as possible.

    Participant's Name *
    Participant's Name
    Participant's Date of Birth *
    Participant's Date of Birth
    Phone Number for Participant (or Parent/Guardian if Participant is under 18) *
    Phone Number for Participant (or Parent/Guardian if Participant is under 18)
    Please Check All that Apply *
    Please Complete this Section if the Participant is under 18. Otherwise, Scroll Down and Click Submit.
    Name of Parent (or Guardian)
    Name of Parent (or Guardian)
    Parent's (or Guardian's) Cell
    Parent's (or Guardian's) Cell
    Please Check All That Apply to Your Child *