Operation Equine Registration Form

Client Registration Form

Operation Equine
Participant Name
Preferred Name
Birthdate*

MonthDayYear
Date
Age*
Gender*
Race/Ethnicity*
Participant Address
Street Address*
Street Address Line 2
City*
State*
Postal / Zip Code*
Participant Phone*
Participant Email*
example@example.com
Emergency Contact*
Emergency Contact Primary Phone*
Emergency Contact Relation*
How did you hear about JoyRide?*
What are your goals for the program?*

ConfidenceCommunicationLearning SkillsSelf-AwarenessFriendshipEmotional RegulationCommunityPhysicalHealthier RelationshipsOther
Branch(es) Served

ArmyMarine CorpsNational GuardCoast GuardAir ForceNavySpecial ForceOther
Year(s) of Service:
ex: 2020 to 2024, or total
Participant's health history and any ongoing medical issues*
Participant Diagnosis*

Acquired Brain InjuryAmputeeAuditory Processing DisorderCognitive DisabilityCerebral PalsyDown SyndromeMental Health ConditionSpinal Cord InjuryDepressionADHDAnxietyAutism Spectrum DisorderDeaf or Hard of HearingCongenital AnomalyEpilepsySeizure DisorderSmith-Lemli-Opitz SyndromeAngelman SyndromeAsthmaBipolarCardiovascularDevelopmental DelayLearning DisabilitySpina BifidaPTSDOther
Check any that apply*

ADHDSubstance AbuseMental Health ConditionDepressionRisky BehaviorAnxietyBipolarGrief/LossImpulsivityIncreased IrritabilityRacing ThoughtsAvoidanceSuspiciousnessInability to enjoy activitiesOther
Additional Information
Have you received a mental health diagnosis? If yes, please describe:*
Have you received outpatient treatment? Are you engaging in any therapies now? If yes, please describe the nature of the treatment
Attendance Policy

If you are unable to make your class time, please give us at least 48hours' notice. If you know of dates you will be absent, please notify the front office or email officemanager@joyridecenter.org. For last minute cancellations, call JoyRide's office at 281-356-5900. Clients will be charged regular tuition fee for cancelations or no shows. Three absences within one semester without notice may result in being dropped from the schedule.

CLIENT PACKET ACKNOWLEDGEMENT

Our website has client packets for each program under Client Info and Registration. Please see the "Operation Equine Client Packet."

I have read the client packet, and am aware of JoyRide Center's client policies. I acknowledge I am aware of the following polices: Tardy, Attendance, Billing.
Date

MonthDayYear
Date
Signature

Clear
ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

Privacy practices are found on the JoyRide Center website, joyridecenter.org/info-and-registration OR contact the office for a copy emailed to you.
Date

MonthDayYear
Date
Signature

Clear
Consenting to this release helps JoyRide Center use photos to promote and fundraise our programs at events and on social media. This also helps prospective clients and parents get a better idea of what a day at JoyRide Center looks like!

To the use and reproduction by JoyRide Center of any and all photographs and any other audio/visual materials taken of me/my son/my daughter/my ward/other family members for promotional printed material, educational activities, exhibitions or for any other use for the benefit of the program. JoyRide policy is that only first names will be used to identify people unless specific permission is given from the parent/client/guardian.
I hereby (check one)*

CONSENTDO NOT CONSENT
Printed Name*
Date

MonthDayYear
Date
Signature*

Clear
Liability Release

l/my son/my daughter/my ward would like to participate in the JoyRide Center, Inc. program. I acknowledge the risks and potential risks of horseback riding and working around or near farm animals. However, I feel that the possible benefits to myself/my son/my daughter/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 JoyRide Center, Inc., its Board of Directors, Instructors, Therapists, Aides, Horse Owners, Volunteers and/or Employees for any and all injuries and/or losses I/my son/my daughter/my ward/other family members may sustain while participating in JoyRide programs. WARNING- Under Texas Law (Chapter 87, Civil Practice and Remedies Code), a farm animal professional is not liable for an injury to or the death of a participant in farm animal activities resulting from the inherent risks of farm animal activities.
Printed Name*
Date*

MonthDayYear
Date
Signature*

Clear
Please complete all needed information and submit to Office Manager, Blake Lewis, blake@joyridecenter.org
Printed Name*
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Client Registration Form

Participant Address