Executive Director PATH Intl. Certified Instructor · No open toe shoes, sandals, or clog type shoes. No slick (jogging type) pants. We would prefer that your participant wore pants

Dear Parents, Participants, or Caregivers,

Welcome to Freedom Hooves Therapeutic Riding Center. We look forward to having you participate

in our riding program. FHTRC provides therapeutic riding to all disabled individuals who can benefit

from this unique and valuable form of therapy. Please read through all the information in this packet

thoroughly. It contains very important information regarding registration of your rider and participation

in the program at FHTRC.

We are currently taking applications for our therapeutic riding program. We have limited riding times

and spots fill up fast so get your paperwork in quickly!

One of our goals at FHTRC is to keep our program affordable to all our participants and families. To

make this possible we have several fundraising events and activities throughout the year. We also

constantly look for grants, donations, and corporate sponsorships for our program and events. At

FHTRC we never want to turn anyone away from our program because of their financial situation.

Therefore, we are always looking for help from all our families and volunteers with our fundraising

efforts and events.

We are very proud of our program and its accomplishments throughout these past years! We would not

be where we are without the support of our wonderful riders, families, board members, donors, and

sponsors. Thank you for your interest in our program and we look forward to having you as part of our

Freedom Hooves family.

Thank you,

Amanda Hale

Amanda Hale

Executive Director

PATH Intl. Certified Instructor

www.FHTRC.org

[email protected]

316-733-8943

FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943

__________________________________________________________________

1.Getting Started

First please complete all paperwork included in this packet. Then either mail (FHTRC, P.O. Box 782622,

Wichita, KS 67278) or scan and email ([email protected]) your completed paperwork in to FHTRC. Once you

completed your paperwork please contact (316) 733-8943, to schedule your evaluation (new participants) or

riding time (returning participants). If you are a returning participant your reevaluation, if needed, will be

completed during your first riding session. All new participants need to schedule a separate evaluation. There

will be a $15 evaluation fee for therapeutic riding participants.

2. Programs

FHTRC offers therapeutic riding sessions and group sessions. Riding time: Each participant’s session will last

30 minutes. This includes mounting and dismounting times for the participant. We allow approximately 5

minutes for mount and dismount which allows each participant approximately 25 minutes on the horse. It is up

to the instructor’s discretion to decrease the time of a session for any reason including the following: client

fatiguing, client medical problems, client complaining of discomfort, client behavior problems, horse fatiguing

or other horse related problems. If a horse problem occurs, we will attempt to complete your session time on

another horse. We want our sessions to be a positive experience for both our horses and all our clients.

***We would highly encourage all parents to attend a volunteer training. Because our program relies

heavily on volunteers there is always a chance that we may have volunteer no shows or cancellations. It is

very helpful to the FHTRC staff to know that we have trained parents able to step in for absent volunteer and

this will also enable your rider to continue with their mounted session as planned. Volunteer training dates are

posted on our website at www.fhtrc.org. If there are NOT enough volunteers to conduct a safe riding lesson a

ground/grooming lesson may be offered in place of the riding session.

Therapeutic Riding Program: Therapeutic Riding participants are scheduled to ride once a week for 30 minutes.

Riding participants must be at least 4 years old. All therapeutic riding participants are instructed by PATH

Intl. Certified Riding Instructors. At FHTRC we have found that our clients improve the most with one on one

attention. Therefore, we mainly offer private lessons with one instructor teaching one client. We do have group

lessons if desired. Goals for therapeutic riding focus on horsemanship skills, educational skills, and leisure

activities. Participants are screened by a certified instructor and their programs are periodically reviewed by the

instructor for changes.

3. Participant Dismissal and Discharge Policy

It is at the discretion of FHTRC’s Executive Director and Program Director to accept or remove a participant

from the program. The results of a risk/benefit analysis will also be considered. Participants who do not adhere

to the rules and procedures or meet the guidelines for eligibility are subject to dismissal or discharge. Possible

grounds for dismissal may include, but are not limited to: conduct endangering another participant, volunteer,

staff member, or horse, conduct endangering themselves, consistent failure to follow safety procedures with

respect to the horses, a gain in weight above the FHTRC maximum levels, failure to cancel in advance for more

than three lessons, or incomplete paperwork. The development of a contraindicated condition or the

deterioration of a condition to the point horseback riding is no longer beneficial or could be harmful to the

participant or where safety for the participant or others has become a concern.

Participant Handbook


Participants at FHTRC shall have no history of inappropriate behavior with fire or any tendencies or history of

abuse or violence directed toward animals or other people. FHTRC reserves the right to deny services to any

individual based upon concerns for the applicant’s safety and/or the safety of the horses, volunteers, staff,

property owners, or for other reasons in accordance with PATH Intl. operating center guidelines.

No participant will be dismissed without an opportunity to discuss the reasons with supervisory staff. The

participant may at any time, for whatever reason, decide to sever the participant relationship with FHTRC.

Notice of such a decision should be communicated as soon as possible.

4. Weight Limitations for All Participants

Maximum weights are listed below, but decisions regarding participation will be based on the availability of a

suitable horse related to the height, weight, cognition, and balance of the participant. Decisions will also be

based on the availability of tall and/or strong volunteers. Weights include the weight of the client plus the

saddle/tack.

• 220lbs. for a well balanced centered rider not requiring sidewalkers

• 180lbs. for an unbalanced rider needing sidewalker assistance

• Each horse has an individual weight limitation based upon the horse’s height, weight, age, and physical

and medical condition

5. Scheduling of a Weekly Riding Time for New Participants

Once the initial evaluation is completed, we will then see if we have a current opening in the FHTRC schedule

that is suitable to meet your participant’s needs. If an opening does not currently exist then we will put your

participant on a waiting list and you will be notified as soon as an opening becomes available. Riding sessions

are typically offered throughout the day and early evening on Monday through Thursday. We do not have

weekend sessions, as we like to leave the arena open to other boarders at the boarding facility. Available riding

times will be discussed at your evaluation.

6. Billing

Therapeutic Riding Lessons are billed on a sliding scale fee per 30-minute ride and will be billed in 8-week

sessions prior to the beginning of the session. If a payment plan is needed please contact the Executive Director

to discuss payment options.

Any participant with an outstanding balance from the previous session will not be allowed to ride until

the balance on the account has been paid or payment arrangements have been made.

7. Cancellations

If FHTRC should cancel a riding session (due to weather or instructor illness, etc.):

• Your fees will be credited toward the next 8 week session

• You will be notified by phone, email, and/or text message for cancellations

• FHTRC will cancel if the wind chill is below 40 degrees or the heat index is above 95 degrees.

• FHTRC will also cancel in cases of extreme weather such as thunderstorm and tornado watches and

warnings, and extremely high winds


If you cancel a riding lesson: You will not be billed for cancelled lessons IF 24 hours notice is given. We

need time to contact volunteers if their client cancels, so please contact the instructor and give notice if you

need to cancel.

FHTRC running late: Any time FHTRC program is running late (as we will at times) we will do our best to get

back on schedule, however, we will offer the participant their full lesson time. We will attempt to notify you

upon arrival regarding the length of wait before your participant will ride.

Participant tardiness: Any time a participant is late, their session time will be decreased accordingly in order for

the schedule to remain intact. If a participant is 15 or more minutes late for a session they will NOT be

allowed to ride for that lesson. We will do our best to provide other activities for the client to participate in

while at the barn, such as grooming.

Make-Up lessons: Make up times are set on Monday’s from 1:00pm-2: 30pm and are on a first come, first serve

basis and volunteer availability. If this does not work for you, another riding time may be able to be worked out.

There is no guarantee because our riding schedule is very full. Only participant cancelled lessons are eligible to

be made up. If a participant is a no-show (no previous notice given), this lesson will not be eligible to be made

up.

8. Scholarships

FHTRC offers full and partial scholarships to all those who need them if funds are available. Scholarship levels

will be approved according to each family’s or participant’s financial needs. We require that all those

requesting a scholarship write a detailed letter to FHTRC stating their financial situation with proof of their

financial need. We also require that all parents/families that participate in the scholarship program assist during

the year with 1-2 fundraising activities that help keep the program affordable to all of our participants. We will

provide a discount form at your request during the initial evaluation along with a list of volunteer activities for

your review (these will include activities that can be completed at the barn or at home). FHTRC has also

instituted a discounted service plan for those that help to raise funds for FHTRC or those that volunteer for

FHTRC.

9. Attire

No open toe shoes, sandals, or clog type shoes. No slick (jogging type) pants. We would prefer that your

participant wore pants instead of shorts, as the saddle can get very uncomfortable with direct skin contact.

10. Children

We ask that children be monitored and in direct vision of the adult at all times while at the facility. Please

review the barn rules with your children prior to arriving at the barn.

11. Dogs and Other Animals

Do not bring dogs or other animals to the barn with you at any time. The exception to this rule is service

animals. Please let your instructor know if you will be bringing a service animal to the lesson with you.

12. Riding Helmets

All clients must wear riding helmets that meet or exceed ASTM regulations. Helmets are provided by FHTRC

for class use, or you may purchase your own individual helmet.


13. Observing Therapy Sessions

Families, siblings, and friends of our clients are welcome to observe the session as long as it does not distract

the client or the horse. We do have a small area with chairs for you. If at any time the instructor feels that the

client is too distracted by observers they may ask them to wait in the office area. We want all of our clients to

get the most they can out of every lesson.

14. Speed Limit

The speed limit at the ranch is 15 mph. This is enforced at all times even if you are running late to a session. If

you continue to not obey the speed limit, you will not be allowed on the ranch anymore. This is the barn

owner’s policy and we support it as we have clients and other boarders riding down the road at times.

15. Communication/ Questions

Email is an inexpensive and convenient way for us to contact you about class cancellations, session information

and program events. It is important that you provide us with an email address that you check frequently.

Please direct questions to your participant’s instructor. If you do not get a satisfactory answer to your question

please feel free to contact the Executive Director at (316) 733-8943.

Thank you very much for your interest in our program. We look forward to working with you this year. Our

goal is to provide a safe atmosphere that allows our clients to have fun and enjoy their time on horseback.

I can be reached, and communicate best, through email at [email protected]. I can also be reached at (316)

733-8943.

Thank you,

Amanda Hale

Amanda Hale

Executive Director, FHTRC

P.O. Box 782622 Wichita, KS 67278

Phone: 316-733-8943

NEW Start date: _______

Returning Orig. Date: _________ Return Date: _______

Physician: Date: ________

Emergency Authorization Treat No Treat

Liability Release

Photo: Yes No

INITIAL: _____ DATE: ___ Office Use Only

Student Application and Emergency Contact Information

GENERAL INFORMATION

Participant’s Last Name: ________________________________ First name: __________________________

Address: ________________________________________ City: _________________ Zip: _______________

Phones: Home: ________________________ Cell: _______________________Work: ___________________

Text notifications for cancellations or important information

E-mail Address: _________________________________________________________________

Please include an email address that you check frequently. Email is a convenient and inexpensive way for us to contact you.

We would like to use it to alert you of cancelations, session information and program events.

DOB: _______________Age: _____ Height: ________ Weight: __________ Gender: M F

School or Employer: ___________________________________________ Phone: ______________________

Teacher: ________________________________________________ Phone: ___________________________

How did you come to know about our program? __________________________________________________

Did you attend Freedom Hooves Therapeutic Riding Center in the past: Yes: _______ No_______

Mother’s/Guardian Information:

Name: _______________________________________ Mailing Address: ______________________________

City: _______________________ State: _______ Zip: __________ Email: _____________________________

Phone #s: Cell: ______________________ Home: ______________________ Work: ____________________

Place of Employment: ______________________________ Occupation: ______________________________

Best way to get a hold of you (Please Circle one): Email Cell Phone Text Message Home Phone Work Phone

Father’s Information:



Phone #s: Cell: ______________________ Home: ______________________ Work: ____________________

Place of Employment: ______________________________ Occupation: ______________________________

Best way to get a hold of you (Please Circle one): Email Cell Phone Text Message Home Phone Work Phone


Student Application and Health History – Page 2

Individual Responsible for Payment Information:



Phone #s: Cell: _______________Home: __________________Relationship to Participant: _______________

Caregiver name (if applicable): ______________________________Phone #: _________________________

Emergency Contact: ________________________ Relation: ______________ Phone: ____________________

Emergency Contact: ________________________ Relation: ______________ Phone: ____________________

Physician’s Name: ___________________________________ Phone: ________________________________

Preferred Medical Facility: ___________________________________________________________________

Health Insurance Company: ______________________________ Policy #_____________________________

Health History

Allergies: ___________________________ Current Medications: ____________________________________

Significant Medical History: __________________________________________________________________

Diagnosis: ________________________________________________ Date of Onset: ____________________

Please indicate current or past needs in the following areas:

Yes No Comments

Vision

Hearing

Sensation

Communication

Heart

Breathing

Digestion

Elimination

Circulation

Emotional/Mental

Health

Behavioral

Pain

Muscular

Thinking/Cognition

Bone/Joint

Allergies


Student Application and Health History – Page 3

Please answer each question to the best of your ability. We use all this information to develop lesson plans and

goals for you or your rider. Please attach a separate sheet with more details if needed.

Medications

Name Prescription Over the Counter Dose Frequency

Other Current Therapies and Frequency:

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Physical Function

Describe abilities/difficulties in the following areas (include assistance required or equipment needed). For

example: Mobility skills such as transfers, walking, wheelchair use, driving/bus riding

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Psycho/Social Function: (e.g. work/school- including grade completed, leisure interests, relationships, family

structure, support systems, companion animals, fears, concerns, emotional struggles, etc.)

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Goals: Why do you want to be a student at Freedom Hooves Therapeutic Riding Center? What would you like

to accomplish? (Balance, independence, etc.)

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

PHOTO RELEASE

I DO I DO NOT

Consent to and authorize the use and reproduction by FREDOOM HOOVES THERAPEUTIC RIDING

CENTER of any and all photographs and any other audio/visual materials taken of me for promotional material,

educational activities, exhibitions or any other use for the benefit of the program.

Signature: Student (if over 18): ___________________________________________________

Signature: Parent or Legal Guardian: ________________________________________________

Date: ____________________________________

Physician’s Form Page 1

P.O. Box 782622 Wichita, KS 67278 Phone: 316-733-8943


INFORMATION FOR PHYSICIAN

Dear Health Provider:

Your patient, ______________________________, is interested in participating in supervised equine activities.

In order to safely provide this service, our center requests that you complete/update the attached Medical

History and Physician’s Statement Form. The following conditions, if present, may represent precautions or

contraindications to therapeutic horseback riding. Therefore, when completing this form, please check which of

these conditions are present, and if so, to what degree:

ORTHOPEDIC

☐Atlantoaxial Instability (including neurologic

symptoms)

☐Coxa Arthrosis

☐Heterotopic Ossification/ Myositis Ossificans

☐Joint Subluxation/ Dislocation

☐Osteoporosis

☐Pathologic Fractures

☐Spinal Joint Fusion/ Fixation

☐Spinal Joint Instability/ Abnormalities

☐ Cranial Deficits

NEUROLOGIC

☐Seizure Disorders

☐Spinal Bifida

☐Chiari II Malformation

☐Tethered Cord

☐Hydromyelia

☐Hydrocephalus/Shunt

☐ None of these conditions are present

MEDICAL / PSYCHOLOGICAL

☐Allergies

☐Animal Abuse

☐Cardiac Conditions

☐Physical/Sexual/Emotional Abuse

☐Blood Pressure Control

☐Dangerous to self or others

☐Exacerbations of medical conditions (i.e. RA, MS)

☐Fire Settings

☐Hemophilia

☐Medical Instability

☐Migraines

☐PVD

☐Respiratory Compromise

☐Recent Surgeries

☐Substance Abuse

☐Thought Control Disorders

☐Weight Control Disorder

OTHER

☐Age – Under 4 years

☐Indwelling Catheters / Medical Equipment

☐Medication – i.e. photosensitivity

☐Poor Endurance

☐Skin Breakdown

Treating Physician Signature: ________________________________ Date: ________________________

Treating Physician Name (please print): __________________________ Date: ______________________

Thank you very much for your assistance. If you have any questions or concerns regarding this patient’s

participation in equine assisted activities, please feel free to contact me at (316) 733-8943.

Sincerely,

Amanda Hale

Physician’s Form Page 1



Amanda Hale

FHTRC Executive Director

SEIZURE DISORDER PARTICIPANTS – If Client does not have seizures write N/A

PATH (Professional Association of Therapeutic Horsemanship Association) recommends the following

information for PATH Operating Centers for clients with seizure disorders:

Would you consider ____________________________________________’s seizures to be: (please rate)

(name of participant)

□ Completely controlled □ Very well controlled □ Fairly controlled by medication

Type of Seizure:

Typical Seizure:

Typical motor activity during seizure:

Description of client’s behavior during post-ictal state: Post-ictal state duration:

Specific directions as to what to do if a seizure should occur at Freedom Hooves Therapeutic Riding Center:

Physician’s Signature: Date:

P.O. Box 782622 Wichita, KS 67278 Physician’s Form Page 3 Phone: 316-733-8943

PARTICIPANT’S MEDICAL HISTORY & PHYSICIAN’S STATEMENT

Participant: ________________________________DOB: ________Height: ________ Weight: ______

Address: _____________________________________________________________________________

Diagnosis: ____________________________________Date of Onset: ____________________________

Past/Prospective Surgeries: ______________________________________________________________

Medications: __________________________________________________________________________

Shunt Present: Y N Date of Last Revision ________________________________________________

Special Precaution/Needs: _______________________________________________________________

_____________________________________________________________________________________

Mobility: Independent Ambulation: Y N Assisted Ambulation: Y N Wheelchair: Y N

Braces/Assistive Devices: ________________________________________________________________

For those with Down syndrome – AtlantoDens interval X-Rays: Date: ___________Result: Pos Neg PATH recommends within the past 5 years and review every year; Physician Discretion for repeat x-ray.

Neurologic Symptoms of Atlanto Axial Instability: ____________________________________________

Please indicate current or past special needs in the following systems/areas, including surgeries:

Yes No Comments

Auditory Visual

Tactile Sensation

Speech Cardiac

Circulatory Integumentary/Skin

Immunity

Pulmonary Neurological

Muscular Balance

Orthopedic

Allergies Learning Disability

Cognitive Emotional/Psychological

Pain

Other Other

To my knowledge, there is no reason why this person cannot participate in supervised equestrian activities. However, I understand

that the PATH center will weigh the medical information above against the existing precaution and contraindications. I concur with a

review of this person’s abilities/limitations by a licensed/credentialed health professional (e.g. PT, PT, SLP, Psychologist, etc) in the

implementation of an effective equine activity program.

Signature: ____________________________________ Date: _________________________________

Name: __________________________________________ Date: ________________________________

Address: ___________________________________________ Title: MD DO NO PA Other ________

Phone: ( ) ______________________________ License/UPIN Number: ____________________


NO CALL/NO SHOW POLICY

WHEN YOU ENROLL AT FREEDOM HOOVES THERAPEUTIC RIDING CENTER, we schedule you on a

regular basis and a horse is prepared prior to each lesson. We also schedule staff and volunteers to meet the

need of the class (both in individual and group).

Please call 24 hours in advance if you will NOT be able to attend your lesson. This helps us to adjust our

program, volunteers and horses for the lessons if needed. If you cannot call 24 hours in advance, please make

sure you call by 8:00 a.m. We will take into consideration emergencies, but PLEASE CALL US.

If you are more than 15 minutes late for your scheduled class you will NOT be able to ride. Please arrive on

time. If you are consistently late we will need to discuss a different time that is more suitable.

If a student does not call and does not show up for class, a NO CALL/NO SHOW FEE of $15.00 will be

charged to the student for that day’s lesson. After three (3) No Call/No Shows you will be dropped from your

class and will have to re-register. If you are on a full or partial scholarship, you will have to reapply.

Thank you for informing us of your unavailability for your scheduled lesson.

We appreciate your understanding and support.

By signing below I agree that I have read and understand FHTRC’s No Call/ No Show policy.

Participant Name: _____________________________________________

Parent/Participant Signature: ______________________________ Date: ___________________



FHTRC Therapeutic Riding Schedule

Please help us to serve you. If you could take a moment and answer the following questions based on your

preferences, we would greatly appreciate it. We are considering how to best make use of FHTRC’s time and

schedule while we seek to meet your needs as well.

Answer the following:

1) Would you prefer morning or evening classes? _________________________

2) What weekday works best for you?

☐MONDAY ☐ TUESDAY ☐ WEDNESDAY ☐ THURSDAY

3) Please list in order the three times of day that would work best for your schedule

P.O. Box 782622 Wichita, KS 67278

Phone: 316-733-8943

FREEDOM HOOVES THERAPEUTIC RIDING CENTER

Billing Policies

FHTRC is committed to providing a quality therapy experience at an affordable rate. The majority of incurred

expenses are financed through private donations, grants and fundraisers. While expenses have increased, we

strive to keep our fees as low as possible.

We determine payment for therapeutic riding based on income. If this payment does not fit into your budget

please indicate below that you are in need of a scholarship. FHTRC will do our best to provide a partial or full

scholarship as need arises.

Fees:

**FHTRC does not bill Insurance or Medicaid**

Evaluations: Evaluations are performed by one of the FHTRC certified instructors for all new participants

desiring to enter the program. Therapeutic Riding evaluation fees for new participants are $15.

Therapeutic Riding: We have a sliding scale fee based on your or family’s income level. Proof of income

level may be asked to submit prior to admittance into the therapy program. Please fill out the section below to

determine your level. Full payment is required prior to the start of the riding session unless other arrangements

have been made.

Scholarships: Scholarships are available if needed and if funding has been secured by FHTRC. Scholarships

are based on your annual income. If you do not qualify for a scholarship we also offer a discounted services

program, which is based on how many hours you volunteer for FHTRC or how much you help raise in

donations. If you need to request a scholarship or discounted services please write a letter to the program

explaining, in detail, your request including specific areas such as financial need, out of pocket expenses,

therapeutic benefits, or other necessary information. All scholarship applications are reviewed at the end of each

session by our scholarship committee. This committee is made up of members of the board of directors for

Freedom Hooves.



PAYMENT AGREEMENT

Responsible Party for payment: _________________________________________________

Family’s Net Income: _________________________________________________________

Clients that can pay are asked to pay as much as they can. If you have any questions please call (316) 733-8943.

Client Name: _________________________________________ DOB ____________________

Sliding Scale Fees Please circle the best level for your income level and continue to the statements below

$85,000 + $55 per lesson

$64,500- $84,999 $45 per lesson

Less than $64,499 $35 per lesson

______ I agree to pay the amount listed on the sliding scale fee

_____ In order to participate in the FHTRC program, I am in need of a partial scholarship

______ In order to participate in the FHTRC program, I am in need of a full scholarship

By signing below I agree that I have read and understand FHTRC’s billing policies.

Participant Name: _____________________________________________

Parent/Participant Signature: ______________________________ Date: _______________________



FREEDOM HOOVES THERAPEUTIC RIDING CENTER

Liability Release

As a volunteer/client/staff/student/board member at Freedom Hooves Therapeutic Riding Center I acknowledge

the risks of a horseback riding program. However, I feel the possible benefits to myself and the participants I

work with are greater than the risk assumed.

I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and

release forever all claims for damages against Freedom Hooves Therapeutic Riding Center, its’ Board of

Directors, Instructors, Therapists, Aides, Volunteers and/or Employees for any and all injuries and/or losses I

may sustain while participating in Freedom Hooves Therapeutic Riding Center program.

WARNING:

Under Kansas law, there is no liability for an injury to or the death of a participant in domestic animal activities

resulting from the inherent risks of domestic animal activities, pursuant to K.S.A. 60-4001 through 60-4004.

You are assuming the risk of participant in this domestic animal activity.

If client/volunteer is under 18 years of age, Parent/guardian must sign.

Name: (Please Print Clearly) _____________________________________________________

Signature: ________________________________________________ Date: ______________

Signature: ________________________________________________ Date: ______________

Parent/Guardian – if minor or legal guardian

D&J RANCH

RELEASE OF LIABILITY

KNOWING THAT RISK IS ALWAYS ATTACHED TO HORSEBACK RIDING AND IN CONSIDERATION OF THE SERVICES

RECEIVED AND BEING DESIROUS OF RECEIVING INSTRUCTION ON THE RIDING OF HORSES BY

______________________ (INSTRUCTOR). I _____________________________ (PARENT/GUARDIAN) OF

_________________________________________________________

I DO HEREBY RELEASE AND DISCHARGE SAID INSTRUCTOR & THE D & J RANCH (DANE AND JENNIFER WADLEY)

OF ANY AND ALL LIABILITY ARISING FROM THE RIDING AND/OR HANDLING OF HORSES UPON THE PREMISES

KNOWN AS THE D & J RANCH, INCLUDING BUT NOT LIMITED TO LESSONS AND/OR DEFECTS IN RIDING

EQUIPMENT (I.E. SADDLES, BRIDLES,ETC…).

I AGREE TO HOLD SAID INSTRUCTOR & THE D & J RANCH HARMLESS FROM ANY AND ALL CLAIMS AND

LIABILITY THAT MAY BE MADE BY MYSELF OR ANYONE ON MY BEHALF INCLUDING COSTS AND REASONABLE

ATTORNEY FEES.

THIS RELEASE IS BINDING UPON MY HEIRS AND ASSIGNS. _________________________

DATE__/__/___

Documents

Executive Director PATH Intl. Certified Instructor · No open toe shoes, sandals, or clog type shoes. No slick (jogging type) pants. We would prefer that your participant wore pants