Professional Development Application

Professional Development Approval Application

Please fill out one form per application
Which Professional Development Training are you Registering for?*
EQUINE ASSISTED THERAPIST CERTIFICATION

We provide certification that is designed to provide comprehensive training for mental health professionals to become competent and effective practitioners of the H.T.C.C. Model of Equine Assisted (Psycho)Therapy.* To be qualified, a board / association must have the ability to revoke registration, certification, accreditation or licensure for ethical or scope of practice violations relating to mental health practice OR be supervised by a professional mental health supervisor who is held accountable by a governing association/body.* Participants must have 300 hours + of recent (last 3 years) horse handling experience. ****If the applicant does not have this direct experience with horses, we can offer on-site training (see Horsemanship Training Below).
Applicant Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a minimum college-level education and training with a diploma in mental health field or mental health scope of practise?*

YesNo
Please state your diploma/degree and include if it includes mental health as a scope of practice *
Please select any of the following that is applicable to you:*

I practice under a governing board/bodyI am held accountable as a member of an association/board or bodyI am under professional supervision by a supervisor who is held accountable by a governing association/board or body
Please describe your training, current role and licensing in the mental health field*
Do you have a minimum of 300 hours of experience handling or caring for horses in the past 3 years?*

YesNo
** Please register for our Pre-Certification Horsemanship Training.**
Please describe your experience
MINIMUM REQUIREMENTS FOR PROFESSIONALS
1. All applicants must have one of the following:
  1. Minimum college-level education and training with a diploma in same.
  2. Degree in a mental health field or include mental health as a scope of practice.
2. Must perform within your scope of practice and follow all provincial / state and / or country laws and regulations regarding said practice.
3. Must prove one of the following*
  1. Applicant practices under a governing board / body.
  2. Applicant is held accountable as a member of an association / board / body.
  3. Applicants is under professional supervision by a supervisor that is held accountable by a governing association / board / body.
4. Must have minimum of two-years experience handling or caring for horses.**
* To be qualified, a board / association must have the ability to revoke registration, certification, accreditation or licensure for ethical or scope of practice violations relating to mental health practice

**If applicant does not have this direct experience with horses, we can offer on-site training (see Horsemanship Training Below).
Applicant Name*

First NameLast Name
Applicant Signature*

Clear
Our staff will contact you within 1 business days to discuss your needs.
EQUINE ASSISTED LEARNING FACILITATOR CERTIFICATION

We provide certification that is designed to provide comprehensive training for equine professionals to become competent and effective practitioners of the H.T.C.C. Model of Equine Assisted Learning.* To be qualified, participants must have 300 hours + of recent (last 3 years) horse handling experience. ****If the applicant does not have this direct experience with horses, we can offer on-site training (see Horsemanship Training Below).
Applicant Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please state your educational background *
Do you have a minimum of 300 hours of experience handling or caring for horses in the past 3 years?*

YesNo
** Please register for our Pre-Certification Horsemanship Training.**
Please describe your experience
Applicant Signature*

Clear
Our staff will contact you within 1 business days to discuss your needs.
PRE-CERTIFIATION HORSEMANSHIP TRAINING
Applicant Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Why do you Want to Complete our Pre-Certification Horsemanship Training?*
Do you have any experience with horses?*

YesNo
If yes, please explain your experience
Applicant Signature*

Clear
Our staff will contact you within 1 business days to discuss your needs.
VOLUNTEER CERTIFICATION
Which Volunteer Certification Program are you applying for?*

Youth Volunteers (12 - 17 years old)Adult Volunteers (18+ years old)
Applicant Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Applicant Parent / Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have horse experience?*

YesNo
If yes, please explain your experience
Tell us Why you Want to Complete our Volunteer Certification Program?*
Volunteer Signature*

Clear
Parent / Guardian Signature *

Clear
Our staff will contact you within 1 business days to discuss your needs.
EQUINE-STIMULATION CERTIFICATION
Applicant Name*

First NameLast Name
Date of Birth *

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a minimum college-level education and training with a diploma in health field or physical health scope of practice?*

YesNo
Please state your diploma/degree and include if it includes physical health as a scope of practice
Please select any of the following that is applicable to you:*

I practice under a governing board/bodyI am held accountable as a member of an association/board or bodyI am under professional supervision by a supervisor who is held accountable by a governing association/board or body
Please describe your training, current role and licensing in the health field*
Do you have a minimum of 300 hours of experience handling or caring for horses in the past 3 years?*

YesNo
** Please register for our Pre-Certification Horsemanship Training.**
Please describe your experience
1. All applicants must have one of the following:
  1. Minimum college-level education and training with a diploma in same.
  2. Degree in a health field or include health as a scope of practice.
2. Must perform within your scope of practice and follow all provincial / state and / or country laws and regulations regarding said practice.
3. Must prove one of the following*
  1. Applicant practices under a governing board / body.
  2. Applicant is held accountable as a member of an association / board / body.
  3. Applicants is under professional supervision by a supervisor that is held accountable by a governing association / board / body.
4. Must have minimum of two-years experience handling or caring for horses.**
* To be qualified, a board / association must have the ability to revoke registration, certification, accreditation or licensure for ethical or scope of practice violations relating to health practice

**If applicant does not have this direct experience with horses, we can offer on-site training (see Horsemanship Training Below).
WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS. READ IT CAREFULLY!

Appointments and Facility
The event or session can be canceled 48 hours before the event/session begins via their client portal at www.horsetherapycanada.com

The Client must arrive at the event 10 minutes before the event/session in order to complete registration and sign-up protocols.

The Client’s session will begin at the time they have scheduled. If the client arrives early, the client is asked to remain in the vehicle until the session begins. The client can meet their therapist at the Horse Therapy Centre of Canada Trailer to answer COVID-19 screening questions at the time of their session.

Any event/session, which starts later than scheduled for any reason, will finish according to schedule (i.e. the event/session will be shorter).

It is imperative that drivers/parents/guardians are on time to pick up their minor child. Therapists are unable to wait with your child to ensure their safety for pickup, if you are late.

In the event that a minor child's driver is late for pickup, the parent/guardian will be charged for the therapist’s time at the rate of $250/hr, a 1 hour minimum will be charged. The next session will not be scheduled until this fee has been paid.

Horse Therapy Centre of Canada has the right to make changes in the Event Timetable, in particular: change the Instructor, replace the Event with another one, or cancel the Event. Such changes only happen in exceptional situations and are not standard practice.

Horse Therapy Centre of Canada has the right to change the location of services within a 30 km radius. Such changes only happen in exceptional situations and are not standard practice.

Client Accountability
The Client and/or Parent/Guardian is obliged to inform the instructor about any health issues and limitations which may affect the Client’s safety and restrict the possibility of performing physical activities.

The instructor has the right to refuse participation to the Client if the Client arrived late and/or is disruptive to the activities. No refunds will be provided in either circumstance.

The instructor may ask the Client to leave the event if they decide that the Client’s behaviour is violating public order, good manners, or Company Terms and Conditions. The instructor may ask the Client to leave if the Client’s health condition is dangerous for the client himself or for other attendees. No refunds will be provided.

The client and/or parent/guardian understands that there is a Zero Tolerance Policy toward aggressive and abusive behaviour towards Horse Therapy Centre of Canada’s staff members, volunteers, program participants, and animals. This includes any abusive or threatening comments, aggressive gestures, physical contact, verbal abuse, and any other behaviour that is deemed unsafe.

I understand that I / my child can be removed from the program with immediate effect and will not receive a refund.

During the event, the Client is obliged to wear appropriate clothing and footwear (no open-toe shoes).

Privacy and Sharing of Information
The Client understands and agrees that the Horse Therapy Centre of Canada regularly uses different forms of medias (photograph, video, etc.) to document the programs. These medias can and will be used by the Horse Therapy Centre of Canada on different media sites (including but not limited to: the company website, Facebook, Instagram, YouTube) and/or for broadcasting on television or radio as determined by the Horse Therapy Centre of Canada.

I authorize the Horse Therapy Centre of Canada and its associated health professionals to collect personal and medical information as documented in my digital file, stored in the Horse Therapy Centre of Canada’s booking system.

I authorize the Horse Therapy Centre of Canada and its associated health professionals to communicate with all parties indicated within the online client profile, as deemed necessary for my beneficial treatment.

I understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission

I understand that if I want the Horse Therapy Centre of Canada to release my information to any third parties, I must fill out the Release of Information form.

No-Refund Policy:
All sales are final. We do not give refunds for canceled or rescheduled events/sessions. The Horse Therapy Centre of Canada reserve all rights to reschedule sessions/events due to low attendance, weather occurrences or extenuating circumstances.

In the rare event that a refund is approved by the Horse Therapy Centre of Canada due to extenuating circumstances, a $250 administrative fee will be charged.
Applicant Signature*

Clear
Our staff will contact you within 1 business days to discuss your needs.
Should be Empty:

Professional Development Approval Application

EQUINE ASSISTED THERAPIST CERTIFICATION

MINIMUM REQUIREMENTS FOR PROFESSIONALS

EQUINE ASSISTED LEARNING FACILITATOR CERTIFICATION

PRE-CERTIFIATION HORSEMANSHIP TRAINING

VOLUNTEER CERTIFICATION

EQUINE-STIMULATION CERTIFICATION