Coaching Intake Form Full Name* Nickname Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail* Birthdate* (if you don’t want to provide your birthdate, please provide your age)Occupation Equine Coaching Session Date Emergency Contact InfoName Relationship PhoneEquine Coaching QuestionnaireHow did you find out about Big Sky Yoga Retreats/Cowgirl Yoga?What experience do you have with horses (describe non-riding experiences, if possible)?What interests you most about learning from horses?What do you hope to gain from your experience with the horses?What life transitions or challenges are you experiencing at this time in your life?What emotional or physical trauma have you experienced in your life (if you feel comfortable sharing)?What type of support system (professional and personal) do you have in your life?Medical & Dietary InfoDo you have any health issues/medical conditions that we need to know about?YesNoIf yes, please explainDo you have any specific injuries that we need to know about?YesNoIf yes, please explainAre you taking any medications?YesNoIf yes, please explainAre you a vegetarian?YesNoAre you a vegan?YesNoDo you have any food allergies or restrictions?YesNoIf yes, please explain Tell us about your food preferences too (i.e. can’t stand chicken, love any kind of beans, etc.) the more specific you are, the better! Please note: we will accommodate all dietary restrictions. Every effort will be made to accommodate dietary preferences, but sorry, we cannot guarantee it, especially if your list is long or complicated.Fitness InfoPlease contact us if you have any questions about your ability to participate in activities. We suggest that you consult your physician about participating following any serious illness or injury. Describe your current fitness routineInclude the activities you participate in (running, weights, swimming, cycling, pilates, etc.), the frequency with which you participate in each activity (how often, how far, how long), how long you have been doing each activity, and any other relevant info.What is the main goal of your current fitness routine?(weight loss, stress reduction, feeling good, etc.)Please give us more detailed info on your yoga experienceWhich styles do you enjoy most, have you attended other yoga retreats, are you a yoga teacher, etc. Otherwise please indicate that you are a beginner.Do you have any specific health and fitness goals you’d like to share with us?Do you have previous riding experience?YesNoIf yes, please describe for how long, what style, etc.Please check box: I understand that there are weight restrictions for horseback riding, for safety reasons. In general, 175-195 lbs. is our max (also depending on your height). Have you ever experienced altitude sickness before?YesNoYour IntentionWhat do you hope to get out of this experience with yoga and horses?Please share your intentions, goals, hopes and dreams, etc.!Do you have any questions or concerns?(please call if you would like to discuss.)Is there anything else that you would like us to know about you? Δ
