intake form Connection Form Your Name(Required) First Last Parent/Caregiver name for 16-18 year olds First Last Preferred Method of ContactEmailPhoneYour Email Address(Required) Email Address Confirm Email Address PhoneAge if under 18 yearsQuestions or concerns for support services (Optional)Do you have interest in (choose all that apply) Wellness sessions Somatic sessions Life coaching sessions Counselling with registered social worker Online zoom sessions In person on the farm Funding accepted Private pay Autism Funding Unit Heritage Christian Online School Fraser Valley Aboriginal Children and Family Services Society Ministry of Children and Family Development Self Design Online School Children's Variety of BC Extended health plan (check with your provider) Other Please note contracts must be approved and in place prior to the first session. AFU clients proof of application submission to AFU is required prior to the first session. How did you find out about us? We do not offer horseback riding in our programs. Please allow up to 72 hours for us to contact you after your form is submitted. Thank you, Carla Webb Δ