Strides Horse Powered Reading Registration Form

Horse Powered Reading & Emotional Support Group
1st Session Time: 8:15-9:45AM

Registration Fees (50.00 per participant) can be paid with Cash or Check and must be completed in order to complete the registration process. Please write check to Freedom Ranch and send to W6801 Colby Factory Road Greenwood, WI 54437. Please thank Freedom Ranch Inc. for keeping the program fees at a resonable cost!!

Only one child may be registered at a time.
Please select the option below on how the $50.00 payment will be made by. Please write check out to Freedom Ranch. Send payment W6801 Colby Factory Road Greenwood WI 54437 to complete registration.

CashCheck
Participant Name*

First NameMiddle NameLast Name
Guardians Name*

First NameLast Name
Guardians Phone Number

Area CodePhone Number
Current Age:*
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail Address where you'd like to receive confirmation and information:*
example@example.com
Phone Number*

Area CodePhone Number
Grade Entering Fall 2023*
Please describe your child's current reading level. *
Emergency Contact Information
Emergency Contact Information*

First NameLast Name
Emergency Contact Relationship *
Emergency Contact Phone Number*

Area CodePhone Number
List any allergies or sensitivities: (medical, food, etc.): (If none, enter none)*
List any chronic illness and or physical limitations camp should know about: (If none, enter none)*
Current Date*

MonthDayYear
Date
PHOTO RELEASE WAIVERI authorize Strides Equestrian Therapeutic Center LLC to take photographs and/or video recordings of me (or my child, if under 18) for use in marketing, promotion, education, and reporting, including printed materials, social media, and the organization’s website.

Yes, I consent to photo/video useNo, I do not consent to photo/video use
WAIVER OF LIABILITY FORM

LIABILITY WAIVER
By signing below, I agree to follow the guidelines and expectations set by the providers during my participation in equine-assisted services, including Horse Powered Reading and emotional support activities at Strides Equestrian Therapeutic Center LLC.

I fully understand that participation in equine and other recreational activities carries inherent risks, including but not limited to physical injury, emotional distress, property damage, and even death. Despite safety measures and precautions taken by Strides Equestrian Therapeutic Center LLC, its staff, volunteers, and agents, I voluntarily choose to participate and assume all risks associated with these activities.

I agree to wear appropriate safety gear—including a certified equestrian helmet—and to follow all instructions, rules, and guidelines as directed by Strides’ staff and providers. I certify that I have no medical or psychological conditions that would interfere with my safe participation.

I hereby release and discharge Strides Equestrian Therapeutic Center LLC, its owners, staff, volunteers, and agents from any and all liability, including claims of negligence, that may arise from my participation in these activities. I understand that I am responsible for any medical or personal costs incurred as a result of injury or accident.

This release applies to all risks, known or unknown, and remains in effect for one calendar year from the date of signing.

SIGNATURE & ACKNOWLEDGMENT
I acknowledge that I have read and understood the Liability Waiver and Photo Release above. I agree to be bound by the terms set forth and understand that signing is a requirement to participate in any programs offered by Strides Equestrian Therapeutic Center LLC.
Signature*

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Date of Signature*

MonthDayYear
Date
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Horse Powered Reading & Emotional Support Group

Emergency Contact Information