Contact Us

Name: All Population Family Fun Day
Start: 2019-12-14T12:30:00-05:00
End: 2019-12-14T15:00:00-05:00

Interested in receiving our services? Fill out this form to apply for participation.

Are you current or former military?*
- Yes
- No
If you are current or former military and interested in our Warrior Mission: At Ease Retreats, please complete our full detailed application on the Warrior Mission: At Ease page Thank you! Click here for application page.
Applicant's Name*
First Last
Age of Applicant*
Parent/Caregiver Name*
First Last
Phone Number*
Email Address*
Enter Email Confirm Email
We are not accepting new participants for Therapeutic Riding and Occupational Therapy Programs*
Thank you so much for your interest in our Equine Therapy programs at Quantum Leap Farm. At this time due to community demand we are at capacity for our Therapeutic Riding program and Occupational Therapy program. Unfortunately we are not currently accepting new clients into these programs or onto the waitlist. Please review the following Equine Therapy centers in the nearby area to see if they may fit your needs: Kiddy Up Ranch, Bakas Equestrian Center, Inspire Equine Therapy Program, Emerald M Therapeutic Riding Center, TherHappy. Please take the time to research the facility to make sure they are appropriate for your situation as each facility is unique in what services they have to offer.
- That's ok, please contact me anyways. I have additional questions.
Program of Interest*
- At EASE (Equine Assisted Self Exploration)
- Warrior Mission: At Ease Retreat
- Family Fun Days
- Educational Internships
Please see Services page for more information on programs.
Special Need, Disability, Injury or Primary Concern*
There is currently a waiting list to receive services from Quantum Leap Farm. After filling out this form, someone will contact you soon with more information.
Consent*
- I consent to my submitted data being collected and stored.
Email
This field is for validation purposes and should be left unchanged.