• Trotting Horse Therapeutic Riding (THTR)

    Trotting Horse Therapeutic Riding (THTR)

    New Client Registration

  • Session Registration:         20

  • Participant Information

  • Responsible Party for Trotting Horse Fees

  • Emergency Information - Required

    Please furnish the name and phone number of a contact person (if under 18, in addition to a parent)

  • It is the responsibility of the participants, parents, or guardians to notify THTR if any of the information on these forms changes during the year the application is in effect.

  • Minors / Clients with Guardians

  • Legal Guardian 1

  • Legal Guardian 2

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  • Medicaid

    NOTE: THTR is covered under Montana Medicaid Community & Home Based Services. In order for our services to be covered by Medicaid, clients are required to be enrolled in a participating Medicaid Waiver program and have a caseworker with the ability to provide a Prior Authorization Referral for services. ANY and ALL charges not covered by Medicaid will be billed and due by the client or guardian.

  • Client Information

    Please fill out ANY that apply, even if therapy is not your primary concern!

  • 3. WHEELCHAIR USE?
     
       
       
    % of time used

  • Trotting Horse Therapeutic Riding (THTR)

    Trotting Horse Therapeutic Riding (THTR)

    Program Policies

  • Client or Legally Responsible Party, please initial the following to indicate your understanding of, and agreement to, THTR’s program policies:

  • * THTR has a 24 hour cancellation policy. With the exception of an emergency or unforeseen event, I will be charged for a scheduled lesson that I miss or that is cancelled within a 24-hr window. If I am missing due to illness or another unforeseen event, I will communicate this to THTR as soon as possible.

  • * Lessons must be paid in full prior to, or the day of the lesson.

  • * All participants must wear boots with a heel (hiking boots etc are fine), unless there is a medical exception.

  • * All participants are to wear a helmet, unless there is a medical exception.

  • * THTR maintains the right to terminate services at any time due to but not limited to abusive actions/ behavior of participant towards horses or staff/volunteers;failure to be able to correct said behavior / actions after it is brought to their attention;unsafe behavior including but not limited to use of drugs/alcohol.

  • * I agree to respect THTR participant, staff and volunteer rights with regard to privacy of information and to keep “professional” confidentiality in all my statements both within and outside of the organization.

  • * I give my consent to THTR to obtain medical care from any licensed physician, hospital, or clinic in case of emergency for any injury that could arise from participation in Trotting Horse Therapeutic activities.

  • * I agree to the current prices as posted on the THTR website or as communicated to me in writing, including but not limited to by text or email, by Cyndi Meyer.

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  • Trotting Horse Therapeutic Riding (THTR)

    Trotting Horse Therapeutic Riding (THTR)

    Horse Activity/Horseback Riding Release of Liability and Indemnity Agreement

  • To be filled out by Participant OR Participant’s Legal Guardian, if applicable

    • Participants under 18 years of age are required to have this filled out and signed bya Legal Guardian

    • Participants who are over the age of 18 and have a Legally Appointed Guardian are required to have this filled out by a Legal Guardian

  • Name of Participant: *

    Name of Legal Guardian filling out form:

    INITIAL each section on left hand side to show you agree

  • * I, the Participant/Legal Guardian, hereby acknowledge agreement to voluntarily participation in the activity of horseback riding and/or other equine related activities offered by Trotting Horse Therapeutic Riding. I sign this waiver and release agreement allowing Participant the access and services provided by Trotting Horse Therapeutic Riding, including but not limited to, barn services, stable and arena usage, and other equine-related activities pursuant to Montana Code Ann. 27-1-725-727. I fully understand that the activity of horseback riding or even being near a horse involves numerous dangers and risks injury to the Participant. I acknowledge that the assumption of all risks involved is my responsibility and I completely release Trotting Horse Therapeutic Riding and its agents, employees, and volunteers from all liability for any and all injuries caused by participation in the general activity of horseback riding

  • * I, the Participant/Legal Guardian, fully understand that an animal (horse),irrespective of its training and usual past behaviors and characteristics, may react or act unpredictably based on instinct or fright, and that even the most gentle horse,when provoked or frightened, may rear, buck, run away, or otherwise act in an unpredictable and dangerous manner. In addition, weather such as thunder, hail,lightning, heavy wind, or snow sliding off the roof, may cause a horse to rear, buck,run away, or otherwise act in an unpredictable and dangerous manner. Having understood these dangers, I fully assume all of the risks involved and completely release Trotting Horse Therapeutic Riding and its agents, employees, and volunteers from liability for any and all injuries to the Participant resulting from the general activity of horseback riding.

  • * I, the Participant/Legal Guardian, fully understand that riding on any type of terrain can be dangerous to the Participant’s horse and to the Participant, and that this danger increases when riding a horse at a faster pace, such as at a trot (jog), canter Trotting Horse Therapeutic Riding is a 501(c)(3) nonprofit organization dedicated to providing therapy riding to Montanans in need. All donations are deductible to the fullest extent of the law.(lope) or gallop. I also understand that this danger increases when riding across an open field, pattern riding (dressage), or jumping. Under these conditions, or even while riding at a slower pace, the Participant’s horse may stumble, be thrown off balance, get caught in a hole or rut, fall, or otherwise be dangerous to the Participant. I also fully understand that the Participant may, at any time, lose control of and /or fall off the horse, or have a collision. I fully assume the responsibility for all these dangers and risks and completely release Trotting Horse Therapeutic Riding and its agents, employees, and volunteers from all liability for any and all injuries to the Participant from the dangers and risks as stated above.

  • * I, the Participant/Legal Guardian, fully understand that animals (horses) and conditions are unpredictable and that the risk of injury and death is inherent to the activity of horseback riding and/or being around horses. I fully assume the responsibility for the risk of injury or death caused by the Participant’s contact with horses and horseback riding. I completely release Trotting Horse Therapeutic Riding and its agents, employees, and volunteers from any and all liability for any and all injuries or death caused by the Participant’s contact with horses/horseback riding.

  • * I, the Participant/Legal Guardian, agree not to sue, claim against, attach the property of or prosecute Trotting Horse Therapeutic Riding, its officers, affiliated organizations, agents, and/or its employees or volunteers for riding and its related activities, whether or not such injury or death was caused by their negligence or from any other cause.

  • * I, the Participant/Legal Guardian, agree to defend, indemnify and hold harmless Trotting Horse Therapeutic Riding and its agents, employees, and volunteers for any injury or death caused by or resulting from the Participant’s participation in the activity of horseback riding and its related activities, whether or not such injury or death was caused by their negligence or from any other cause.

  • * I, the Participant/Legal Guardian, agree that this agreement shall be legally binding upon me, my family, my heirs, my estate, assigns, legal guardians and my personal representatives.

  • * I, the Participant/Legal Guardian, have carefully read this agreement and fully understand its content. I am aware that I am releasing certain legal rights that I otherwise may have and I enter into this release of liability and indemnity agreement on behalf of myself of my own free will.

    THIS IS A RELEASE OF LIABILITY. DO NOT SIGN OR INITIAL THE RELEASE IF YOU DO NOT UNDERSTAND AND/OR AGREE WITH ITS TERMS.

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