Horse Boy Playdate Application Form

Please provide as much information as possible in order to help us fully understand the needs of yourself and your family and accommodate you as best we can. In addition we require two written or verbal references from non-family members who have known you and your family for at least two years. Suitable referees include therapists, teachers and other professionals who have worked with you or your child. Please include these references in your application e-mail and provide a phone number or e-mail address so we can follow up if necessary. Disclaimer: We have a limited number of places available for Horse Boy Playdates. Please therefore be as detailed and honest as possible when filling out the above information. Completion of this application form does not guarantee you a place at one of our playdates.

Personal Information

Please provide us with the full name(s) of the parent/guardian who will be attending the playdate with your child

Information about your child

In this section we will ask you a series of questions about your child. Please be as detailed as possible in your answers. This information will help us tailor our playdates to your child in order for them to get as much out of them as possible.
 
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Education

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Interests/Passions

Please check which (if any) of the following your child likes to play with/do *

Horse Experience

Information about your expectations

Scholarship Application

If your application is approved it will entitle you to twelve weekly sessions at which point you will need to submit a renewal form. Please note that if you miss two or more sessions without prior arrangement we will discontinue your scholarship. For more information please see our liability form. The Horse Boy Foundation exists to provide time in nature with horses and other animals to low income families free of charge. For that reason we do not charge for our playdates. We do, however, gratefully accept donations if you can afford them and have several levels of suggested donation which are dependent on your household income which are listed below. Less than $25,000 $25,000 - $50,000 ($50 per month) $50,000 - $100,000 ($100 per month) $100,000+ ($200 per month)
Do you rent or own your home? *
Combined Household Income Bracket (annually) *

Checklist

Before submitting this form please read the following information and check each box once you have done so. This is important information and we want to ensure that you have read and understood it fully before attending a playdate.
 
Please check to indicate you are aware and accept the rule below
Under Texas Law (Chapter 47, Civil Practice and Remedies Code), an equine professional is not liable for an injury to or death of a participant in equine activities resulting from the inherent risk of equine activities *
Parents or guardians are at all times responsible for all their children. If you do not watch your children at all times we will have to ask you to leave *
You, your child and any other person you bring are required to wear proper footwear around the horses at all times. Closed toed shoes are mandatory. Exceptions can be made if your child has sensory issues upon completion of an additional liability form. *
Helmets will be provided but it is your responsibility to ensure that they are worn at all times on the horse. Exceptions can be made if your child has sensory issues upon completion of an addtional waiver. *
Playdates are by confirmed appointment only. Please do not show up without an appointment. If you do arrive and there is nobody there please leave immediately. This is a working farm we might have dangerous tools, equipment and horses that are not child safe around the house when we are not expecting children. *
Please give at least 48 hours notice of a cancellation. If you cancel more than two times, we reserve the right to cancel your scholarship and offer it to another family. *
We reserve the right to cancel a playdate, however to the best of our ability, will give at least 24 hours notice. *
No pets please unless previously authorized by Horse Boy Staff. All pets will have to undergo a evaluation before being brought to a playdate. *