Participant Application - Wilderwood Equine Therapy and Rescue

Name(required)

Parent/Guardian Name (for E/ASEL: complete ONLY if applicant is under the age of 18)

Email(required)

Phone Number(required)

Location (City, State)(required)

Please check the following if you're interested in the seven-day residential Hautism program for adult participants: Aged 18 or older

Minimum Grade 8 reading level

Able to attend a seven-day immersive program in New Mexico

Be autistic (self diagnosis OR professional)

I would like information on residential B&Bs in the area

I am interested in a Spring session

I am interested in a Summer session

I am interested in a Fall session

I would like to be considered for a tuition scholarship

I would like to be considered for an accommodation scholarship

Please check the following if you're interested in the E/ASEL Equine/Autistic program for participants between the ages of 8 and 18. Aged between 8 and 18

Able to commit to attending Wilderwood 90 minutes a week for 8-week session

Autistic (self diagnosis OR professional)

My child is interested in attending a Spring EA/SEL session

My child is interested in attending a Summer EA/SEL session

My child is interested in attending a Fall EA/SEL session

I would like my child to be considered for a full or part-fee scholarship

Questions or Comments?

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