Programme Interest Form for Students Name(Required) First Last Age(Required)School(Required)Diagnosis (if known)(Required)Height(Required)Weight(Required)Mobility Status(Required) Independent Needs Assistance Dependant (Equipment Used) Programme you're interested in(Required) Life Skills Equine Services Environmental Education Reason for Interest in WindReach programmes (please include any goals/objectives)(Required)Availability(Required) During the school day After School Financial Assistance Required?(Required) Yes No Contact InformationGuardian Email(Required) Guardian Name(Required) First Last Guardian Phone(Required)
