Equine Specialist - Pre-Approval Form

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Equine Specialist Handling and Skills Workshop - August 27-29, 2021:
Pre-Approval Registration Form

Participant Basic Information

* Indicates required field

Name *

First

Last

Day Phone Number *

Evening Phone Number *

Email *

Do you have any physical limitations or dietary restrictions? *

Yes No

If yes, please describe: *

Participant Relevant Experience

Your Primary Role: *

Mental Health Professional* Equine Specialist

*All Mental Health Professionals must be appropriately licensed to practice psychotherapy (or graduate students under the supervision of an appropriately licensed professional trained in play therapy) to practice EPPT. Please check with your state laws to make sure that you will be allowed to practice in your state.

Please list any relevant licenses and/or certifications that you hold: *

Are you currently facilitating or co-facilitating equine-assisted counseling and psychotherapy sessions? *

Yes No

Are you seeking certification as PATH Intl. ESMHL? *

Yes No

Estimated years of full-time work wth equines (For example: 2,000 hours would roughly equate to 1 year of full-time work with equines). *

Please describe equine experience including but not limited to: personal experience with owned equines, participation in clinics, workshops, or riding lessons, or professional experience with equines *

Which option are you mosted interested in? *

Full Workshop: 2.5-Day Skills and Handling + PATH Intl. ESMHL Prep (August 27-29) Skills and Handling Only: 2-Day Workshop (August 27-28) PATH Intl. ESMHL Prep Only: Half Day (August 29)

Submit Registration Form

After submitting this pre-registration form, you will receive a follow-up email within 24 hours indicating if you have been approved for full participation. Once approved, you will receive a link to pay and complete your registration. Please note: your seat at the workshop will only be reserved once payment is complete.

Contact Us
Phone: (682) 334-3784

Email: office@equineconnectioncounseling.com

Mailing Address: P.O. Box 122692, Fort Worth, TX 76126

Equine Specialist Handling and Skills Workshop - August 27-29, 2021:​Pre-Approval Registration Form

Participant Basic Information

Participant Relevant Experience

Equine Specialist Handling and Skills Workshop - August 27-29, 2021:
Pre-Approval Registration Form