Power of Hisan Registration — Minaret Therapeutic Services

Power of Hisan Equine-Assisted Therapy Learning Program starts April 29th-30th & May 6th-7th from 9am-12pm in Parker, Colorado. Register Below!

*Submitting a registration form does not guarantee a spot in the program as spots are limited and on a qualifying basis. Please await confirmation from Amina at Minaret directly to confirm your teen’s spot, thank you!

Participant's Name

First Name

Last Name

Participant's Date of Birth

YYYY

Participant's Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Participant's Current Grade Level

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Parent/Guardian's Phone Number

(###)

###

####

Parent/Guardian Email

Hey teen/parent/guardian! What goals would you like to meet during this Power of Hisan group?

Hey teen/parent/guardian! Please tell us a few things about your teen including any sensory sensitivities, allergies, special dietary needs, or any additional information you find that might be helpful

Does your teen has a official mental health diagnosis? If so, please list both current and past diagnoses here

How did you hear about this group?

If you were referred to this group or have selected other, please let us know who referred you or where you found out about this group in the additional information section of this form. Thank you!

If you or your teen have any additional information or comments, please list here

I acknowledge that this program does not and shall not tolerate any discrimination on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, in any of its activities or operations.

Yes

I acknowledge that with registering for this program, I/my child are committing to all session dates included. I further acknowledge that if I/my child misses any of the scheduled session dates, that I understand that the full benefits of the program may not apply and that I do not hold Minaret Therapeutic Services or Colorado Equine Specialist liable for any missed benefits or consequences from missing sessions.

Yes

Let’s Talk!