Equine Connections Registration Form

Participant Name*

Preferred Name

Birthdate*

Date

Age*

Gender*

Race/Ethnicity*

How did you hear about JoyRide?*

Street Address*

Street Address Line 2

City*

State*

Postal / Zip Code*

Client Phone (or primary contact)*

Parent/Guardian 1 (For Minors)

Full name*

Parent/Guardian 1 Primary Phone*

Parent/Guardian 1 Primary Email*

example@example.com

Parent/Guardian 1 Address (if different from above)

Parent/Guardian 2 Full Name

Parent/Guardian 2 Primary Phone

Parent/Guardian 2 Email

Emergency Contact Name*

Emergency Contact Primary Phone*

Emergency Contact Relation*

Client Medical History*

Client Psychological History*

Current Medications*

Please list any physical changes in the past year*

Please list any psychological changes in the past year*

Does the client participate in any therapies?*

YESNO

Any additional information or behaviors JoyRide staff should be aware of?*

What are the participants major goals at JoyRide Center?*

Contraindications

If any of the conditions below are present, please get in touch with the office for more information.
Medications – i.e. photosensitivity
Allergies
Blood Pressure Control
Medical/Psychological
Animal Abuse
Perpetrate abusive behaviors
Dangerous to self or others

Billing Policy
JoyRide appreciates and depends on tuition being paid in a timely manner. Clients are billed at the beginning of each month for the prior month’s services, and payment is due upon receipt. Bills are emailed to the address you designate on this registration form. Private pay clients will not be charged for classes canceled by JoyRide; however, if you cancel with less than 48 hours' notice or do not show up for a lesson/session, you may be billed your class fee. Each student will be allowed one unexcused absence per semester. If clients become two months behind in payments, they risk being withdrawn from the program. Due to generous support, JoyRide has a Tuition Assistance Fund. You can find the application on our website or contact Blake Lewis at Blake@JoyRideCenter.org. Tuition and fees are payable to JoyRide Center by cash, check, or bank draft through QuickBooks invoicing. Payments can be placed in the “Pony Express” box at JoyRide or mailed to JoyRide Center, 29550 Tudor Way, Magnolia, TX 77355.

Attendance
Volunteers, horses, and staff are assigned when you register for a semester, and look forward to working with you each week. If you cannot make your class time, please give us at least 48 hours’ 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 may be charged regular tuition fee for no shows. Three absences within one semester without notice may result in being dropped from the schedule.

Billing Email

example@example.com

Responsible Party Signature*

Responsible Party Name*

Responsible Party Phone Number*

Waivers

Photo Release:

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/myward/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 of Parent/Guardian or Participant*

Date*

Date

Signature of Parent/Guardian Participant*

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 l/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 of Parent/Guardian or Participant*

Date*

Date

Signature of Parent/Guardian or Participant*

CLIENT PACKET ACKNOWLEDGEMENT

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

Date

Signature*

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*

Date

Signature*

Application Submission

Please complete all needed information and return to office manager, Blake Lewis, blake@joyridecenter.org.

Printed Name of Parent/Guardian or Participant*

Date*

Date

Signature of Parent/Guardian or Participant*

Client Registration Form