Pre-Survey for Adults

Thank you for registering!

Please take a few minutes to complete the following survey. The information you provide will be kept strictly confidential and is only used by Project Horse staff to ensure we are best able to meet participant needs.

Participant's Name

First Name

Last Name

Email Address

Phone Number

(###)

###

####

Birth Year

Name or Type of Program You Will Be Attending

How Did You Learn About This Program?

Please Check All that Apply

Environmental Allergies

Food Allergies

Diagnosis or Medical Condition

Need Special Accommodations

Other

None of the above

Provide Details for All Items Checked Above (or write N/A if you selected "None of the above").

What Do You Feel Are Your Greatest Strengths?

What Do You See as Your Biggest Challenge(s)?

What Are Your Goals for Coming to Project Horse?

Do You Have Any Special Concerns or Requests?

Pre-Survey for Adults

Project Horse Inc.

CLIENT SERVICES & FACILITY

ADMINISTRATIVE OFFICE