BEND Therapeutic Riding Registration 2022

Application process:
The following application process MUST be completed prior to the student’s first ride:
1) Application form completed and submitted
2) Physician Referral and any additional medical forms completed and submitted (atlanto-axial verification for riders with Down syndrome)
3) Acknowledgement of Risk Form read, signed and submitted
4) Post-dated cheques submitted for the full riding session, dated for the first of every month & made payable to BEND Therapeutic Riding. For direct electronic payment or individuals who rely on funding through an outside agency, the individualized payment plan must be clearly outlined by email to jess@bendtherapeuticriding.ca prior to the first lesson. Applications are only valid for one riding session and must be resubmitted each new 10 week session in order to continue riding at BEND Therapeutic Riding.

Attendance at lessons:
BEND Therapeutic Riding offers consistent, individualized programming. In order to best serve individuals, lessons are offered on a weekly basis. Therapeutic gains, and success with any program for any individual, take time and commitment. Therefore, attendance at the weekly riding lessons is required. A total of 2/10 absences during riding session for any reason not discussed prior to acceptance into the riding program could lead to dismissal from the program. (Extenuating circumstances such as surgery/medical procedures etc will be taken into consideration.)

* Required

Email*

example@example.com

All regulations are put in place to ensure the success of programming and accommodation of client needs. Safety and consistency are necessary for successful programming. *

Should BEND Therapeutic Riding cancel a lesson, as much notice as possible will be given and the lesson will be made up at a separate time or that riding lesson's fees reimbursed, at the Head Instructor's discretion
Should a rider fall ill or need to cancel a lesson, 24 hours notice will be required in order for the lesson to be re-scheduled at a separate time or the fees reimbursed, at the Head Instructor's discretion. If 24 hours notice is not given, the lesson will not be rescheduled and the lesson fee will be forfeited to BEND Therapeutic Riding.
Inquiring about rescheduling a planned missed lesson is encouraged and can be discussed on a case by case basis.
Payment: Riding Applicants will receive a riding schedule to determine the dates and number of lessons each month. Use this schedule to determine any lessons you will miss. These planned absences must be communicated with the Head Instructor prior to billing and payment prior to the beginning of riding session to avoid paying for those lessons.

Rider Dress Code : Each student is required to dress appropriately for riding. This includes all of the following *

A properly fitting ASTM/SEI riding helmet ( We have helmets here for use, however we recommend purchase of your own)
Boots with a small heel
Long pants to prevent chafing against the saddle (year round)
Gloves in winter (Gloves are preferred over mits for better hand function)
Riding gloves highly recommended at all times (year round)
Layers in winter (long johns are preferred over ski pants, and upper body layers that can be removed are beneficial should a rider get warmer during the lesson.

Client First Name*

Client Last Name*

Date of Application*

Address*

City, Province*

Postal Code*

Phone Number (Primary)*

Phone Number (Secondary)

Emergency Contact Name*

Emergency Contact Phone Number*

Parent(s)/Guardian(s) if applicable

Parent(s)/Guardian(s) Address (if different from client address above)

Parent(s)/Guardian(s) City, Province

Parent(s)/Guardian(s) Postal Code

Parent(s)/Guardian(s) Email

Parent(s)/Guardian(s) Phone

Parent(s)/Guardian(s) Emergency Contact (Name, Phone)

Date of Birth*

Age*

Height*

Weight*

Preferred Riding Time (We will do our best to accommodate week day and time slot preferences)*

Morning 8am-11am (Last lesson slot runs an hour until 12pm noon)Afternoon 12pm-3pm (Last lesson slot runs an hour until 4pm)Evening 4pm-7pm (Last lesson slot runs an hour until 8pm)

Potential Conflicts (please inform of any days or times that will be a conflict for scheduling times)*

I would like to participate in BEND Therapeutic Riding program.

I acknowledge the risks and potential for risk, of horse back riding. However, I feel that the possible benefits to myself/my child/my ward 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 BEND Therapeutic Riding, it's owner, Instructors, Therapists, Aides and employees for any and all injuries and/or losses I/my child/my ward may sustain while participating in BEND Therapeutic Riding.

Signature: Type your full name (rider over 18yrs or Parent/Guardian)*

Date (MM/DD/YYYY)*

I hereby consent to and authorize the use and reproduction by BEND Therapeutic Riding of any and all photographs and/or any other auto visual materials taken of me/my child/my ward, for promotional material, educational activities, exhibitions, or for any other use for the benefit of the program.

Signature: Type your full name (rider over 18 years or Parent/Guardian)*

Date (MM/DD/YYYY)*

I hereby authorize BEND Therapeutic Riding to release to it's instructors and staff, such information as may be necessary to a beneficial and safe riding program.

Rider's Name*

Signature: Type your full name (rider over 18yrs or Parent/Guardian)*

Relation to Rider (if applicable)

Date (MM/DD/YYYY)*

BEND Therapeutic Riding Registration 2022

Regulations

Client Registration

Rider Details

Liability Release

Photo Release

Information Release