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Horses4Heroes Program Registration

This horse therapy/support group is designed for Veterans and their families. It will run 8 Wed nights starting March 13th 5:00-6:00. Registration Fee is $10/person.

Participant Information

Participant Name

First Name

Last Name

Participant Phone

Date of Birth

00/00/0000

Please check all that apply

I am a Veteran

I am a spouse of a Veteran

I am a child of a Veteran

Other

Guardian Name if under 18 years old

First Name

Last Name

Guardian Email

Verify Email

Guardian Phone

Participant Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Guardian Address if different that client's

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Referred By:

Medical Consent Form Information

Each participant will need to sign a liability release form that includes a medical release form.

Optional Upload: Signed Liability Release Form File Upload

Use this to upload your completed liability release form or complete one the 1st day of sessions

Payment Options

Mail or drop off cash or check to Bit of Hope Ranch 5001 CR Wood Rd Gastonia, NC 28056

Pay by check or cash

online/cc

Online Payment

$10 - Registration Fee