Mindfulness with Horses

Participant Intake Form

Welcome!
I’m so glad you’ll be joining a Mindfulness with Horses session.
This short form helps me tailor the experience to your needs, ensure everyone’s safety, and make sure you get the most out of your time with the horses.

Please complete this form before your session.

Before submitting your details, please review our Terms of Service here

Name

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Emergency Contact Name & Phone Number

If you booked the session for more than just yourself, please provide the names and email addresses of everyone in your group:

Please note - each participant will still need to complete this form themselves. I will follow up with anyone who hasn’t submitted it yet.

Name & Email 1:

Name & Email 2:

Name & Email 3:

Name & Email 4:

Name & Email 5:

A Bit About You

What brought you to a Mindfulness with Horses session?

How have you been feeling lately? (e.g., calm, stressed, curious, tired, open, excited…)

What would you most like to get from your session? (e.g., relaxation, connection, confidence, clarity…)

Have you spent time around horses before?

Yes

A little

Have you practiced mindfulness or meditation before?

Regularly

Occasionally

Not really

Is there anything I should know to make the experience more comfortable for you? (e.g., anxieties, accessibility needs, sensory sensitivities)

Health & Safety

Please read the following and acknowledge:

Horses are sensitive, living beings who respond to human energy and behaviour. While we take every care to ensure safety, working around horses carries inherent risks. Participants agree to follow instructions and respect the horses’ space. This session is a mindfulness experience, not coaching, therapy or a riding lesson.

I have read and understood the above and agree to participate responsibly.

I have read and agree to the Terms of Service

Full Name

(If participant is under 18, please provide parent/guardian name)

First Name

Last Name

Today's date

YYYY

Relationship to Participant (if under 18)

Anything Else?

Feel free to share any thoughts, questions, or intentions you have for your session.

Thank you! I really appreciate you taking the time to fill this out. The horses and I can’t wait to share a mindful, grounding experience with you soon.