One moment please...
Herd By a Horse Autism Group fall 2017

This programs serves children 7-12 years old that stuggle with sensory disorder and autism challenges.  Sessions are $35/session or $200 for paying for all 6 upfront.  THIS SESSION IS FULL BUT PLEASE COMPLETE THE FORM BELOW FOR A WAITING LIST OPTION.

Client Information
*

First Name
Last Name
*

00/00/0000
*
*

First Name
Last Name
*

*

*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Medical Consent Form Information
Each participant will need to sign a liability release form that includes a medical release form.


Use this to upload your completed liability release form
DO NOT PAY BEFORE THE THERAPIST CONFIRMS THAT YOU ARE IN THE GROUP. Mail or drop off cash or check to Bit of Hope Ranch 5001 CR Wood Rd Gastonia, NC 28056
$