Mentorship Enrollment Form

Session Program Enrollment

The heart of our program is to provide a safe place for youth to experience the hope, healing, and love of Jesus Christ.
We offer our mentorship program every winter, spring and fall in 11 week blocks. Each block consists of one session a week for a continuous 11 weeks (holidays excluding).

Your youth(s) will be thoughtfully paired with a mentor for all 11 weeks. During this time they will walk alongside a mentor who will grow with them as they experience God’s love through his creation and a mentoring relationship. Each session is equipped with activities with or without animals, life skill opportunities, chores around the farm, etc. Each session includes a time of devotion to encourage youth with the hope and love of Jesus Christ.

If you are interested in enrolling your child, please fill out the form below to get the process started. Once enrollment is complete, staff will contact you with next steps!
Information
Youth's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Grade*
Age*
Name of School attending
Parent /Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact - (DIFFERENT than above)*

First NameLast Name
Relation to Youth *
Phone Number*
Please enter a valid phone number.
Health Card Number *
Medical Notes - Dietary restrictions, allergies or any other relevant medical information that would affect the participation in the program.*
Medical Authorization: I hereby give permission to hospital and or clinic staff to administer all reasonable and necessary medical care in case of illness to me while in session with my mentor in the event that I am unable to consent myself.*

Yes
Signature*

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Date*

MonthDayYear
Date

River's Edge Haven of Hope's Waiver Form

The heart of our program is to provide a safe place for youth to experience the hope, healing, and love of Jesus Christ.
Parent/Guardians Name*

First NameLast Name
Enrolled Youth's Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
A Parent or Guardian must Initial Below for Each Paragraph

River's Edge Haven of Hope
Signature* AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS - This agreement shall be legally binding upon me, the registered participant, and the parents or legal guardian thereof. River's Edge Haven of Hope located at 1 Haldimand Rd. 17, in Dunnville will hereafter be known as THIS FARM. If a minor, my heirs, estate, assigns, including all minor children and personal representatives; and it shall be interpreted according to the laws of the province and county of THIS FARM'S physical location as noted above. If any clause, phrase, or word is in conflict with provincial law then that single part is null and void. The term "HORSE" herein shall refer to all equine species.
Signature* REGISTRATION OF PARTICIPANTS AND AGREEMENT PURPOSE - In consideration of the signing of this agreement, I, the parent or legal guardian(s), do hereby voluntarily request and agree to the above named youth participating in activities at THIS FARM such as:
- Arts and Crafts
- Horsemanship
- Small Animal Care
- Wood Shop
- Water Activities (Fishing, Canoeing, Kayaking)
- Forest Activities (Hiking, Scavenger Hunts, etc.)
- Bible Study
- Group Activity Events
As a client ( referred herein as a PARTICIPANT) at this farm, the participant will be matched with a Mentor that has been screened by this Farm. The activity options will be decided on by the participant and his/her mentor and are for instructional/ educational/ recreational purposes only. Please make a note here of any program option (s) you would like the participant to be exempt from: * .
Signature* NATURE OF THIS FARMS HORSES - I UNDERSTAND THAT: THIS FARM chooses its program horses for their calm dispositions and sound basic training as is required for use for BASIC HORSEMANSHIP and THIS FARM follows a rigid safety program. Yet, no horse is a completely safe horse. Horses are 5 to 15 times larger, 20 to 40 time more powerful, and 3 - 4 times faster than a human. If a horse is frightened or provoked, it may divert from its training and act according to its natural instincts which may include, but are not limited to: stopping short, changing directions or speed at will, shifting its weight, bucking, rearing, kicking, biting, or running from danger.
Signature* CONDITIONS OF NATURE AND INSPECTION OF PREMISES - I UNDERSTAND THAT: THIS FARM is not responsible for total or partial acts, occurrences, or elements of nature that can scare a horse, cause it to fall, or react in some other unsafe way. SOME EXAMPLES ARE: Thunder, lightning, rain, wind, snow sliding from a roof, wild and domestic animals, insects, reptiles, which may walk, run or fly near or bite and sting a horse or person; and irregular footing on groomed or wild land which is subject to constant change in condition according to weather, temperature, and natural and man-made landscape. The participant and parent or legal guardian have inspected THIS FARMS facility and are satisfied that all premise conditions are safe for the participant's intended purpose, usage and presence upon THIS FARM'S premises.
Signature (OPTIONAL) PHOTOGRAPHS, VIDEO PRODUCTIONS, AUDIO PRODUCTIONS, WEBSITE PRODUCTIONS AND TELECASTS · I AGREE THAT: River’s Edge Haven of Hope requests the right to use any photo and/or film the participant, that may be published in any River’s Edge publication/film/website or any other media item. I realize that any photo(s) and/or film taken will be used for promotional use only and will not be distributed beyond this use.
Signature* SESSIONS AND PAYMENTS: I UNDERSTAND AND AGREE THAT: THIS FARM offers sessions on an individual basis and that sessions are offered free of charge. In cases of inclement weather, participant or mentor cancellation, or other unforeseen occurrences, THIS FARM reserves the right to reschedule sessions at the participant and facilitators convenience. PARTICIPANTS not appearing for sessions, who do not contact THIS FARM may lose their place within the program.
Signature* SESSION PURPOSES: I UNDERSTAND THAT: THIS FARM is a Christian organization that seeks to offer a safe place for youth to experience the hope, healing and love of Jesus Christ. In doing this, I UNDERSTAND that mentors and employees will be using prayer and the Bible openly as encouragement in the sessions with the participants.
Signature* PARTICIPANTS UPON ARRIVAL ARE EXPECTED TO: Arrive in appropriate clothing as outlined in our dress code. Bare feet, sandals, slides, crocs are NOT ALLOWED during sessions while in direct contact with horses. Participants are also expected to exhibit proper conduct while on premises at THIS FARM including abiding by the Farm Rules, and to follow instructions given by employees, mentors or volunteers of THIS FARM. THIS FARM will not accept dangerous, disrespectful or inappropriate behaviour from parents, guardians, siblings or participants while on farm premises. If you have problems that need to be addressed, you are expected to do so with your mentor or the program director in private. Failure to exhibit proper conduct and behaviour will result in a forfeiture of your session and the possibility of immediate cancellation of services provided by THIS FARM.
Signature* I UNDERSTAND THAT no one is allowed on the property that is under the influence of alcohol or recreational and/or illegal drugs. There is absolutely no smoking or vaping on THIS FARM'S property. Failure to comply with the above noted rules by the participant or parent/guardian will result in the session being forfeited and all persons asked to leave THIS FARM.
Signature* LIABILITY RELEASE- I AGREE THAT: In consideration of THIS FARM allowing my participation, under the terms set forth herein, I, the participant, or the parent or guardian thereof a minor, do agree to hold harmless and release THIS FARM, its owners, instructors, facilitators, mentors, agents, employees, volunteers, board members, contract laborer's, officers, members, premises owners, affiliated organizations, and insurers from legal liability due to THIS FARMS ordinary negligence, and I do further agree that except in the event of THIS FARMS gross and willful negligence, I shall bring no claims, demands, actions and causes of action and/or litigation against THIS FARM and ITS ASSOCIATES as stated above in this clause, for any economic and noneconomic losses due to bodily injury, death, property damage, sustained by me and/or my minor child or legal ward in relation to the premises and operations of THIS FARM to include while handling, participating in any equine session, or otherwise being near horses owned by or in the care, custody and control of THIS FARM.
WARNING: THIS FARM IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES.

*** All Parents or Legal Guardians must sign below after reading this ENTIRE document***
SIGNER STATEMENT OF AWARENESS:
Signature* I/WE, THE UNDERSIGNED, UNDERSTAND THAT THIS MENTORING PROGRAM IS NOT A SUBSTITUTE FOR PROFESSIONAL COUNSELLING. THERE ARE NO LICENSED COUNSELLORS ON STAFF AT RIVER’S EDGE HAVEN OF HOPE.
Signature* I/WE, THE UNDERSIGNED, HAVE READ AND DO UNDERSTAND THE FOREGOING AGREEMENT, WARNINGS, RELEASE AND ASSUMPTION OF RISK. I/WE FURTHER ATTEST THAT ALL FACTS RELATING TO THE APPLICANT'S PHYSICAL CONDITION, EXPERIENCE, RELATIONSHIP TO GUARDIAN/PARENT AND AGE, ARE TRUE AND ACCURATE.
Signature* I/WE, THE UNDERSIGNED, UNDERSTAND THAT RIVER’S EDGE HAVEN OF HOPE IS A CHRISTIAN FAITH-BASED MINISTRY.
Parent/ Guardian's Name*

First NameLast Name
Parent/ Guardian's Signature*

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THANK YOU FOR ENROLLING!

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Session Program Enrollment

Information

Program Enrollment

Session Availability

River's Edge Haven of Hope's Waiver Form

A Parent or Guardian must Initial Below for Each Paragraph

WARNING: THIS FARM IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES.

SIGNER STATEMENT OF AWARENESS:

THANK YOU FOR ENROLLING!