Appendix 1. Program Information Form

Program Information

Program Name:

__________________________________

Program Goal(s):

__________________________________

Lesson Types:

☐ Unmounted lessons

☐ Mounted lessons

Group Sizes:

☐ Private (1)

☐ Semi-private (2)

☐ Group (3+)

Discipline(s) Offered:

Clientele Information

Horsemanship Level:

☐ Beginner

☐ Intermediate

☐ Advanced

Lesson Type*:

Horsemanship

☐ Recreational

☐ Competitive

☐ Adaptive Equestrian Sport

☐ Adaptive/Therapeutic Riding

☐ Adaptive Driving

☐ Interactive Vaulting

☐ Other (specify): __________________________

Equine-Assisted Learning

☐ Education

☐ Organization

☐ Personal Development

☐ Other (please specify): __________________________

Therapies Incorporating Horses

☐ Physical Therapy

☐ Occupational Therapy

☐ Speech Therapy

☐ Psychotherapy

☐ Counseling

☐ Other (specify): __________________________

Client Needs:

☐ No identified support needs / Able-bodied

☐ Physical disability / Mobility-related challenges

☐ Cognitive disability (e.g., intellectual disability, brain injury)

☐ Neurodevelopmental condition (e.g., autism, ADHD)

☐ Mental health condition (e.g., anxiety, PTSD, depression)

☐ Sensory disability or disorder (e.g., vision or hearing loss)

☐ Social or emotional challenges

☐ Other (please specify): __________________________

Ages:

__________________________________

Weight:

__________________________________

Note: For definitions of terminology, see Wood, W., Alm, K., Benjamin, J., Thomas, L., Anderson, D., Pohl, L., & Kane, M. (2021). Optimal terminology for services in the United States that incorporate horses to benefit people: A consensus document. The Journal of Alternative and Complementary Medicine, 27(1), 88–95. https://doi.org/10.1089/acm.2020.0415