**This form is for Individuals ONLY.** – If you are an organization with volunteers, please CLICK HERE.

Team Qualification Evaluation Fees
$50 per Handler
Plus
$10 per Evaluation
(Evaluation = 1 handler with 1 equine)

    First Name (required)

    Last Name (required)

    Age (Must be 18 or older) (required)

    Your Email (required)

    Please Confirm Email (required)

    Phone (required)

    Address (required)

    City (required)

    State (required)

    Zip Code (required)

    Do you currently perform animal assisted therapy with an equine? (required)

    Name of Organization/Farm (required)

    Equine Information

    Equine #1:

    Type of Equine (required)

    Age of Equine (min. age is 1 year) (required)

    Name of Equine (required)

    Equine #2:

    Type of Equine

    Age of Equine (min. age is 1 year)

    Name of Equine

    Equine #3:

    Type of Equine

    Age of Equine (min. age is 1 year)

    Name of Equine

    Equine #4:

    Type of Equine

    Age of Equine (min. age is 1 year)

    Name of Equine

    Equine Health Documents (required)

    Please upload the health documents listed below for each equine:

    1. Current Vaccination Records (as required in your area)
    2. Current Negative Coggins Test

    **After submitting this form - you will be redirected to a payment page to submit payment.**