Pony Pals Intake Form
Horse Powered Reading - A Brand New Kind of Learning with Horses!
Pony Pals
Participant Intake Form
Thank you for your interest in Pony Pals at Horses Healing Hearts. This form helps us understand your child's learning style, comfort level, and goals so we can create a safe and supportive experience.
Participant Information
Child's Name:
Date of Birth:
Age:
Grade in School:
Parent / Guardian Name:
Phone:
Email:
Address:
Emergency Contact Name:
Emergency Contact Phone:
School & Learning Information
School Name:
Teacher or Reading Specialist (if applicable):
Does your child currently receive any learning supports?
Does your child have an individualized Education Plan (IEP) or 504 Plan?
If yes, what are the primary areas of support?
Reading Experience
How would you describe your child's current reading ability?
Does your child enjoy reading?
Does your child feel comfortable reading aloud?
What reading challenges have you noticed?
Baseline Literacy & Confidence Snapshot
Reading Confidence
Reading Engagement
Attention During Learning Tasks
Emotional Response to Reading
Primary Goals for Participation (choose up to two)
Experience with Animals & Horses
Has your child previously interacted with horses?
Comfort level around animals
Medical & Safety Information
Does your child have any medical conditions we should be aware of ?
Does your child have any allergies?
Is your child currently taking any medications that may affect participation?
Behavioral & Emotional Considerations
Are there any triggers, sensitivities, or behavioral needs we should understand?
What strategies help your child feel free and successful?
Parent / guardian Goals
What are you hoping your child gains from participating in Pony Pals?
Consent
I understand that Pony Pals is an experiential learning program involving interaction with horses in a structured and supervised environment.
Parent / Guardian Name:
Date:
Signature:
Identify.
Horse Powered Reading® integrates social-emotional learning with academics; thus allowing students see and experience reading with their entire mind, body and emotions by creating metaphors for the skills involved in reading.
Experience.
Students interact with horses from the ground, while using toys and props to identify obstacles and learn five critical reading skills - phonemic awareness, decoding, vocabulary, fluency, and comprehension.
* Session goals vary depending upon the needs of the individual or group and ages.
Connect.
Issues affecting learning are identified and made visible by the client, through the use of obstacles (toys and props), which symbolize stumbling blocks that get in the way of understanding. Issues getting in the way of academic and social-emotional growth are addressed by our expert team in the moment. Sessions allow students a chance to reflect on what they are experiencing and provide an opportunity to create new patterns of learning in a supported environment.
Have Questions?
Learn more about how our Horse Powered Reading® programs work and how we can support your youth's goals.
Ready To Add Some
Mounted Horse Power Into Your Students' Reading?
We have taken Horses Powered Reading® to another level by offering Mounted Horse Powered Reading®.
We use the same principles and learning styles only incorporate Mounted Riding Lesson as part of this program. These 4-week workshops are on the farm and offered as an after-school program.
*Stay Tuned for Our Summer Series.