Client Registration Form — Wild Hearts Equine Connection

Wild Hearts Equine Connection Client Registration Form

Full name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile

(###)

###

####

Date of Birth

YYYY

Relationship/Marital Status/Children

What do you do during a normal day?

What brings you to Equine Assisted Learning?

What is your experience with horses, if any?

Previous Coaching/Counselling or Experiential Learning Sessions? (If so, what was useful, and what was unhelpful?)

What do you consider to be your greatest strengths?

How do you currently support, strengthen and nurture yourself?

Do you know your preferred style of learning?

What activities have meaning and heart for you?

What do you consider your most important values?

Do you believe you are living congruently with these values?

How do you respond when you are in a really challenging situation?

What are your top 3 goals, either short or long-term, at the moment?

What are your top 3 challenges at the moment? Is there something in your life that you would like to change?

Are there major objectives or gains that you wish to achieve from Equine Assisted Learning?

The session is one-on-one and designed exclusively for you, according to the information you provide on this registration form. We recommend that you take your time to answer the questions on the form thoroughly, as this will help us tailor the session to your specific needs. The more effort you put into answering the questions, the greater the benefit you will derive from the session.

Please be sure to return this form 3 working days before your session to give us time to prepare. Rest assured that all sessions are confidential, and you can discuss anything with your practitioner, knowing that your personal information will not be shared with anyone else.

Please dress appropriately for an outdoor session with flat, comfortable, closed-toe shoes or boots, and a hat.

Wild Hearts Equine Connection Client Registration Form

Wild Hearts Equine Connection Wanaka