Visit Request Application

Minis on the Move

Please complete and submit this form to request a visit from High Hopes’ ‘Minis on the Move’ program. Scheduling is subject to availability, and visit fees vary based on location and duration. 

Contact Information

Organization/School Name(Required)

Contact Name(Required)

Position/Title(Required)

Phone(Required)

Email(Required)

Visit Details

Preferred Visit Date

MM slash DD slash YYYY

Alternative Visit Date

MM slash DD slash YYYY

Requested Visit Duration

1 Hour2 HoursHalf-DayFull-Day

Expected Number of Participants(Required)

Age Range of Participants(Required)

Address of Visit Location(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Goals & Accommodations

What are your goals for this visit? (check all that apply)(Required)

Social interaction & engagement

Emotional support & well-being

Sensory & motor skill development

Educational experience

Other Goals? (Write below)

Additional Information

Is there a suitable outdoor or indoor space for the visit? (e.g., gym, courtyard, common area)(Required)

Yes

No

Will staff be available to assist during the visit?(Required)

Yes

No

How did you hear about "Minis on the Move"?(Required)

Agreement & Signature(Required)

I understand that completion of this form does not guarantee a scheduled visit and that availability is subject to confirmation by High Hopes Therapeutic Riding

I agree

Signature(Required)

Date(Required)

MM slash DD slash YYYY