Therapeutic Riding Expression Of Interest Form

Therapeutic Riding Expression Of Interest Form
Therapeutic Riding is a form of treatment that involves horseback riding as a means of improving physical, emotional, and mental well-being.

It is primarily used for individuals with various physical, emotional, and cognitive disabilities, including autism, cerebral palsy, PTSD, and developmental disorders.

Therapeutic Riding Sessions at ADEC are conducted by Jessie Ihrcke, a certified Therapeutic Riding instructor.

Please note:
- Your application is considered pending until the Therapeutic Instructor reviews your details and can confirm your place
- Sessions are subject to availability
YesNo

YesNo

Parent/Guardian's first name*
Parent/Guardian's last name*
Relationship to the Participant*
Parent/Guardian's occupation*
Parent/Guardian's ph. no.*
Parent/Guardian's email*

Participant's Details
First name*
Last name*
Date of birth*

DayMonthYear
Please note: minimum age is four (4) years old
Gender*
Phone number*
Email*
Height (cm)*
Weight (kg)*
For safety reasons, please note the maximum weight is 65kg.
Occupation*
Nationality*
Residential address*
Your passport size photo*

Please upload a photo of yourself which will be used for your membership ID card. Maximum 2MB file size.
Cancelof
Date of birth (old)*
Please note: minimum age is four (4) years old
Please list your preferred days for riding lessons (please note: Riding School is closed on Saturdays)*
Emergency contact name (#1)*
Emergency contact ph. no. (#1)*
Emergency contact name (#2)*
Emergency contact ph. no. (#2)*

The following screens will ask you to complete the medical information for the Participant.

Please provide as much detail as possible, as this will help the Therapeutic Instructor make her assessment.

Medical history*
Please give us as much information regarding the medical history / diagnosis, as well as any additional information you regard as important for us to know.

Medications*
Please list any current medications and dosages.

Allergies*
Please list any known allergies, including medications and environmental

Recent surgeries or hospitalisations*

Seizure history (if not applicable, please write "n/a")*

Mobility considerations (if not applicable, please write "n/a")*
Please state any mobility aids used. E.g. wheelchair, walker, crutches.

Riding experience
Additional comments or special needs

By signing this form, you acknowledge and agree to the following terms:

a) Membership and lesson fees are non-refundable and non-transferable.

b) You and your child will comply with all rules, policies, and regulations set by the Abu Dhabi Equestrian Club.

c) The Abu Dhabi Equestrian Club does not accept responsibility for any accidents that may occur on its premises.

d) Your entry and presence on the Abu Dhabi Equestrian Club grounds constitutes your consent to be photographed, filmed, and/or otherwise recorded. You grant permission for the release, publication, exhibition, or reproduction of any recorded media of your appearance, for any purpose, in perpetuity, in connection with the Abu Dhabi Equestrian Club and its initiatives, including, but not limited to, use on websites, social media, news, and advertising.

e) You will be added to the Abu Dhabi Equestrian Club's mailing list, from which you may unsubscribe at any time.

f) Full payment is required in advance to confirm your sessions.

g) We are currently unable to provide a female-only riding experience. It is essential for beginners to have a groom assist with lead-reining and provide support during riding sessions.

h) It is at the discretion of the Riding Instructor to determine when a rider is safe to transition from lead-rein assistance to riding unaccompanied.

By signing this form, you also acknowledge and agree to the Horse Riders Agreement:
1. I understand that riding, regardless of experience level, carries inherent risks, and that horses may react unpredictably.
2. I accept the risk of falling off and potential injury.
3. I agree to follow all safety instructions provided.
4. I understand that wearing an appropriate riding hat and body protector may reduce the severity of an injury in the event of an accident, and I agree to always wear a riding hat while riding.
5. I understand that wearing a body protector is optional.
6. I agree to provide accurate and honest information to my coach regarding my abilities, riding experience, any past accidents, and any medical conditions that may affect my ability to ride.
7. I confirm that, to the best of my knowledge, all provided details are correct.
8. I have read and understand the Horse Riders Agreement, acknowledging the inherent risks of riding. I accept these risks and agree that the Accredited Professional Coach will not be liable for injury or property damage, unless caused by their negligence.
9. If signing on behalf of a minor, I have explained the Horse Riders Agreement to my child, and I accept the risks on their behalf. I further agree that the Coach and the Abu Dhabi Equestrian Club will not be liable for injury or property damage, unless caused by their negligence.
Parent or Guardian's signature*

Clear
Signature*

Clear
Should be Empty:

Therapeutic Riding Expression Of Interest Form

Participant's Details