2026 Children's Program Scholarship Application

Participant First Name *

Participant Last Name *

Birthday *

Household Information

Parent / Legal Guardian Full Name

Email

Phone 1

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Number of Adults in Household *

Number of Children in Household *

Is the participant currently receiving free or reduced lunch at school *

Demographic Information

The following questions are optional and help us understand who we are serving as we seek grants and community funding.

Participant Gender *

Participant Ethnicity & Race *

Hispanic or Latino

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Middle Eastern or North African

Another race or ethnicity, please specify

Prefer not to answer

Primary Language Spoken at Home

Does the participant identify as having a disability? Participants should be able to mount, dismount and engage in horse related activities with minimal physical assistance. *

If accommodation needed, please explain

Financial Information

Approximate Total Household Income Range *

Is your family currently experiencing any of the following (select all that apply): *

Recent job loss

Medical expenses

Single parent household

Multiple children enrolled in programs

Unexpected financial hardship

Other

SCHOLARSHIP REQUEST

We encourage families to contribute at a level that feels manageable. Your contribution helps us extend financial support to more participants.

SUMMER CAMP Scholarship You are Seeking (amount your family can contribute):

Equellness Kids SUMMER WORKSHOP Scholarship You are Seeking (amount your family can contribute):

Equellness Kids AFTERSCHOOL Scholarship You are Seeking (amount your family can contribute):

Is your child aware of and excited about attending camp?

Please share anything you would like us to understand about your current circumstances and how this program would support your child.

CONSENT & CONFIRMATION

I confirm that the information provided is accurate to the best of my knowledge. I understand that scholarship funds are limited and awarded based on need and availability. *

I agree

PRIVACY NOTICE & COMMUNICATION PREFERENCES

Data Privacy & Consent

Email Opt-In: I consent to receive emails from Equellness Center with updates, wellness resources, and occasional promotions. I can unsubscribe at any time.

Phone Call Opt-In: I consent to receive phone calls from Equellness Center regarding appointments, services, and occasional promotions.

Text Message Opt-In: I consent to receive text messages from Equellness Center, including appointment reminders, wellness information, and occasional promotions. Message frequency varies. Message and data rates may apply. Reply STOP to opt out at any time.

Equellness Center is committed to protecting your privacy. We collect and use personal data—such as contact information and cookies—solely to enhance your experience and improve site functionality. For more information, please visit our Privacy Policy.

Privacy Policy

Account Creation

Create an account to save your information and access our online portal!

Login Name

Password

Retype Password