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What is your ethnicity?
Does the child have an Individual Education Plan? If so, what kind?
Please list any current allergies, medications, and/or medical conditions that LyonHeart Equine Assisted Learning needs to be aware of.
What other concerns (behavioral, emotional and/or academically ) do you have?
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I am applying for program assistance and have or will submit a program assistance application form.
Minor Participant Consent
I, the parent/legal guardian, give my authorization for LyonHeart Equine Assisted Learning to provide services for the above minor and any emergency medical services.
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