Indigo Trails Farm

Equine Assisted Learning • CLTS Program

Program Inquiry & Enrollment Form

Thank you for your interest in our Therapeutic Equine Assisted Learning Program. Please fill out the form below to help us better understand your needs and how we can assist. We will follow up with you as soon as possible.

This form may be completed by a parent or guardian or by a CLTS case worker or professional referral on behalf of a child. Please complete all sections that apply — your information helps us prepare for the most meaningful possible first conversation.

Fields marked with * are required.

Section 1- Who Are You

Inquirer Type *

Section 2 - Your Contact Information

First Name *

Last Name *

Your Role/Relationship to Child *

Email *

Phone *

Case Worker Contact

Case Worker Organization

Case Worker Email

CLTS Funding

Parent's First Name *

Parent's Email *

Parent's Phone *

Section 3 - About the Child

Child's First Name *

Child's Last Name *

Child's Date of Birth

Child's Age *

Child's Grade

Child's School

IEP or 504 Status

Section 4 - Program Goals & Needs

Goals Description

Section 5 - Child's Profile & Considerations

Horse Experience

Sensory Considerations

Communication Style

Behavioral Notes

Child's Interests

Section 6 - Health & Safety

Allergies

Physical Considerations

Section 7 - Scheduling & Logistics

Scheduling Preferences

Start Timeline

Section 8 - Anything Else?

Additional Notes

Referral Source