Workshop Application — Miranda Carey - Equine Facilitated Psychotherapy

Application Form
for Workshops

All personal information you provide to us will be respected as confidential and your content details kept privately at all times.

Name

First Name

Last Name

Phone

(###)

###

####

Name of Workshop:

Date of Workshop you'd like to attend:

YYYY

Occupation

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact and Telephone Number

Are you currently with a counsellor/psychotherapist?

Yes

If not, do you readily have access to a counsellor/psychotherapist?

Yes

Please describe any special dietary needs you may have:

Please describe any particular medical or physical needs you may have when working with and around the horses:

Is your interest in the workshop:

Personal

Professional

Both

Briefly share your experience with horses (please note equine experience is not necessary for this work):

Please describe your experience in groups:

What would you like to learn from participating in this workshop?

How did you hear about the workshop?