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Neurodiverse Program Inquiry Form

Thank you for your interest in Silver Saddle's Equine-Assisted Learning Program.

Please complete this brief form so we can learn about your goals, answer your questions, and help determine whether our program is the right fit for you or your family.

Every participant is unique. The information you share will help us recommend the most appropriate program and prepare for a safe, welcoming, and individualized learning experience.

Participant's First Name *

Participant's Last Name *

Date of birth *

Age

Parent/Guardian Name *

Relationship to Participant *

Phone *

Email *

Educational Support

Does the participant currently have an IEP, 504 Plan, or other educational support plan?

Select an option

If yes, please describe the areas of support or attach relevant documents below.

Physical Limitations

Does the participant have any current physical limitations, injuries, medical conditions, or physician-imposed restrictions that may affect your ability to participate safely in equine-assisted learning activities?

Select an option

If yes, please explain:

Health, Sensory & Accessibility

Are there any allergies, sensory sensitivities, communication preferences, or other considerations that would help us provide a safe and supportive experience?

Select an option

If yes, please explain:

Does the participant carry or require any emergency medication (EpiPen, inhaler, seizure medication, etc.)?

Select an option

Please describe the participant's experience with animals and horses.

Select an option

Comfort Around Horses

Select an option

Strengths, Interests & Motivation: What activities, interests, or strengths does this participant enjoy? What motivates or encourages participation?

What situations can be challenging?

Loud noises

Transitions

Transitions

Unexpected changes

Large groups

Certain textures

Heat

Insects

Other

If other, please explain

Safety Considerations: Does your participant have any behaviors or support needs that staff should be aware of to help maintain a safe experience around horses? (For example: running or elopement, climbing fences or gates, difficulty remaining with the group, impulsive movements, fear responses around animals, aggression toward others, self-injurious behavior, or difficulty following safety directions.)

Select an option

If yes, please explain

Goals (multi-select)

Confidence and self-esteem

Emotional regulation

Communication

Social connection

Executive functioning

Problem-solving

Responsibility

Independence

Self-advocacy

Following routines

Working with animals

Spending time outdoors

Enjoyment

Other

If other goals, please explain:

Preferred days:

Check all that apply.

Preferred times:

Check all that apply.

Method of Communication:

Check all that apply.

Payment Method *

If other payment method, please explain:

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Privacy Policy | Terms of Service | SMS Terms of Conditions

Please Note: Silver Saddle is not currently a Regional Center vendor. Families participating in the Self-Determination Program may be able to access services through an approved financial management service (FMS) if permitted by their person-centered plan. Participants are responsible for confirming funding eligibility with their Regional Center and/or FMS before services begin.

1900 Riverside Dr

Glendale, CA 91201

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