Honored Elders Application

TROT - Honored Elders Application

To ensure coordinated care, Therapeutic Riding of Tri-Cities (TROT) staff and volunteers are provided with information about participant’s abilities

First name

Last name

Birthdate

Gender

Male

Female

Height

Weight

Age

Address

Phone

Emergency Contact

Emergency Contact Phone Number

Do you have previous experience with horses? If so, please describe:

How many years of experience?

Physical Ability Information

Helps us to provide a safe and supportive experience.

Please list any medical conditions, injuries, or physical limitations we should be aware of:

Cognition and Processing Skills

Please describe any sensitivity in the following areas:

Do you have any diagnosed cognitive disabilities (i.e. intellectual disability, traumatic brain injury, dementia, autism, etc,)? If yes, please describe.

Do you have challenges with memory, attention, or problem-solving? If so, please explain.

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TROT - Honored Elders Application

Physical Ability Information

Cognition and Processing Skills

Get in Touch

104 E. 41st Place Kennewick, WA 99337

(509) 412-0112

info@trot3cities.org

Community Partnership

Legal

TROT - Honored Elders Application

Physical Ability Information

Cognition and Processing Skills

Get in Touch

​

104 E. 41st Place Kennewick, WA 99337

(509) 412-0112

info@trot3cities.org

​

Community Partnership

Legal

​