Skip to content
Volunteer
Search
Search
DONATE
About Us
Who We Are
Our Team
Our Herd
Testimonials
News
Non-Profit Docs
Programs
Apparel
Donations
Calendar
Blog
Contact Us
Menu
About Us
Who We Are
Our Team
Our Herd
Testimonials
News
Non-Profit Docs
Programs
Apparel
Donations
Calendar
Blog
Contact Us
CODE OF ETHICS
IRS VERIFICATION
Who We Are
Our Team
our herd
testimonials
news
Non-profit docs
programs
apparel
donations
Calendar
blog
contact us
volunteer
FILL OUT THE PRELIMINARY APPLICATION BELOW
Precautions & Contraindications
Prospective Participant Name
DOB
Height
Weight
Address (street address, city, state, zip code)
Doctor Name
Doctor Phone Number
Behavior Concerns (i.e. elopement, aggression)
Please describe mobility level/needs. Do they require support while sitting?
Health Concerns/Diagnoses (i.e. hemophilia, seizures, Down Syndrome, implanted devices)
Is Axial Skeleton closed? (for Down Syndrome only)
Date of Last Seizure (if applicable)
Contact Name
Contact Phone
Contact Email
Relationship to Participant
In Case of Emergency Call
How did you hear about us?
What outcomes are you hoping will result from time at Stir-n-Up Hope?
We Are Ready To Hear From You