Strides Horse Powered Reading Registration Form

StrideRise: Summer Learning Enrichment Program

Horse Powered Reading & Emotional Support Group
Registration Fees (50.00 per participant/Freedom Ranch will cover other costs) 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.
Participant Name

First NameMiddle NameLast Name
Guardians Name

First NameLast Name
Guardians Phone Number
Format: (000) 000-0000.
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
Format: (000) 000-0000.
Grade Entering Fall 2026
Please describe your child's current reading level.
Please Select the appropriate class:

Ages 6-7 I 8:30-9:15am Monday & Thursday July 6th, 9th, 13th, 16th, 20th, 23rd, 27th, 30th
Emergency Contact Information
Emergency Contact Information

First NameLast Name
Emergency Contact Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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.
WAIVER OF LIABILITY

Liability Waiver
By signing below, I agree to follow all guidelines, instructions, 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 understand that participation in equine and other recreational activities involves inherent risks, including but not limited to physical injury, emotional distress, property damage, and, in rare cases, serious injury or death. Despite reasonable safety measures and precautions taken by Strides Equestrian Therapeutic Center LLC, its owners, staff, volunteers, and agents, I voluntarily choose to participate and assume all associated risks.

I agree to wear appropriate safety equipment, including a certified equestrian helmet when required, and to follow all instructions, rules, and safety guidelines provided by Strides’ staff and providers. I affirm that I do not have any medical, physical, or psychological conditions that would prevent me from participating safely.

I hereby release, waive, and discharge Strides Equestrian Therapeutic Center LLC, its owners, staff, volunteers, and agents from any and all liability, claims, demands, or causes of action, including those arising from negligence, that may result from my participation in these activities. I understand and agree that I am responsible for any medical expenses or other costs incurred as a result of injury or participation.

This waiver applies to all risks, whether known or unknown, and remains in effect for one (1) calendar year from the date of signing.

Signature & Acknowledgment
I acknowledge that I have read and understand this Liability Waiver (and Photo Release, if applicable). I agree to be bound by its terms and understand that signing this document is required for participation in any programs offered by Strides Equestrian Therapeutic Center LLC.
Signature
Date of Signature

MonthDayYear
Date
Should be Empty:

StrideRise: Summer Learning Enrichment Program

Emergency Contact Information