Equine Facilitated Learning

Loving Thunder Therapeutic Riding, Inc. PO Box 44517 Rio Rancho, NM 87174 505-554-9493 fax 505-288-3097

Participant's Application and Health History Equine Facilitated Learning

Qualification for free attendance (check one): At-risk

I agree to adhere to the attendance policies of Loving Thunder Therapeutic Riding, Inc as follows: My child will attend all scheduled lessons, unless they are ill. I understand that not showing up for a lesson without calling at least 24 hours in advance is non-refundable and cannot be made up.

Privacy Policy: We will not share your information in any way unless you have requested in writing such disclosure.

Do Not Consent to and authorize the use and reproduction by Loving Thunder Therapeutic Riding, Inc. of any and all photographs andany other audio/visual materials taken of me for promotional material, educational activities, and exhibitions or for any other use for the benefit of the program. Client, Parent or Legal Guardian Signature:

Horseback Riding Release of Liability and Indemnity Agreement

hereby acknowledge that I and/or my legal guardian on my behalf have voluntarily registered to participate in an activity of horseback riding with Loving Thunder Therapeutic Riding, Inc. I fully understand that the activity of horseback riding, or even being near a horse, involves numerous dangers and risks of injury to me. I acknowledge that the assumption of all the risks involved in my responsibility andI completely release Loving Thunder Therapeutic Riding Inc and its agents from all liability for any and all injuries caused by my participation in the general activity of horseback riding. Please initial to show thatyou

I fully understand that an animal (horse)irrespective of its training and usual past behavior and characteristics, may act or react 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 wind, thunder, hail, lightening, or snow sliding off of 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 Loving Thunder Therapeutic Riding, Inc and its agents from liability for any and all injuries to me from the general activity of horseback riding. Please initial to show that you agree I fully understand that riding on any type of terrain can be dangerous to my horse and me and that this danger increases when riding a horse fast, such as a canter (LOPE) OR AT A GALLOP. Under these conditions, or even while riding at a slower pace, my horse may stumble, be thrown off balance, get caught in a hole or rut, fall, or otherwise be dangerous to me. I also fully understand that I may, at any time, lose control of and/or fall off my horse, or have a collision. I fully assume the responsibility for all of these dangers and risks, and completely release Loving Thunder Therapeutic Riding, Inc and its agents from all liability for any and all injuries to me from the dangers and risks as stated above. Please initial to show that you agree I fully understand that animals (horses) and conditions are unpredictable and that the risk of injury or 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 my contact with horse and horseback riding. I completely release Loving Thunder Therapeutic Riding, Inc. and its agents from any and all liability for any and all injuries or death to me caused by my contact with horses and/or horseback riding. Please initial to show that you agree

I agree not to sue, claim against, attach the property of or prosecute Loving Thunder Therapeutic Riding, Inc, its officers, board members, affiliated organizations, agents and / or its employees for horseback riding and its related activities, whether or not such injury or death was caused by their negligence or from any other cause. Please initial to show that you agree

I agree to release the State of New Mexico and all of its agencies, agents, contractors, servants and employees from liability for any acts of Loving Thunder Therapeutic Riding, Inc causing injuries arising out of premises operation, acts of independent contractors, products completion, or personal injuries sustained due to Loving Thunder Therapeutic Riding, Inc's negligence in connection with providing services under this contract. Please initial to show that you agree

I agree to defend, indemnify and hold harmless Loving Thunder Therapeutic Riding, Inc. and all of its officers, board members, affiliated organizations, agents and employees for any injury or death caused by or resulting from my participation in the activity of horseback riding and its related activities, whether or not such injury or death was caused by their negligence or form any other cause. Please initial to show that you agree This agreement shall be legally binding upon me, my family, my heirs, my estate, assigns, legal guardians, and my personal representative. Please initial to show that you agree I have carefully read this agreement and fully understand its contents. 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. Please initial to show that you agree

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

Participants under 18 years of age requires the signature of a parent or legal guardian.

In the event of an emergency, contact:

At Loving Thunder we are concerned about your safety and the safety of our horses. Please remember that horses are prey animals, they can be unpredictable if put into a "fear for life" situation. You are responsible to keep yourself, your horse and others around you safe. 1. Parking is only permitted in the designated parking lot; please do not park on Jackson Loop roadway. 2. Volunteers are required to sign in and out on Volgistics or the Volunteer Log provided in LT tack room. Names tags must be worn while signed in for volunteering at Loving Thunder. 3.Parents are responsible for the conduct of your children while on Loving Thunder property. 4. Do not enter restricted areas. Restricted areas have signs posted. 5. Visitors should remain only in designated areas during lessons. 6. Do not enter the arena, stalls or round pens where horses are present unless an equine staff member has cleared 7. No alcoholic beverages or smoking is permitted on premises. 8.Wear boots or sturdy shoes with ample ankle support and low heel - no open toe shoes. 9. Wear jeans or appropriate riding pants - no dresses or extremely short shorts allowed. 10. Riders are required to wear an approved ASTM/SEI riding helmet at all times during lesson participation and riding of any equine. Volunteers are required to wear an approved ASTM/SEI riding helmet while riding any equine on the facility premises. If you do not have your own riding helmet, Loving Thunder will provide upon request. 11. Never feed the horses treats. Some of our horses have special dietary needs and treats may cause illness. 12. For our horses' safety, a weight limit for participants needing assistance is 180lbs. If you have concerns with this please ask a member of the equine team for details. 13. Never stand directly in front of or behind a horse. 14. Always be aware of your surroundings - Be aware of the people and animals around you. 15. Always be aware of your safety in working with equine at all times (we will cover this during your visits to Loving Thunder 16. Always close a gate behind you (your horse will know the second you don't and make his or her escape 17. Be aware of what you place in proximity to your horse or horse's stall. 18. If your horse is not tied - never let go of your lead rope or reins (also to be covered during lessons 19. Notify the staff immediately to any injury to yourself or your horse - no matter how small it may be. 20. Always inspect your horse and equipment prior to any lesson and notify staff of any issues. 21. Most of all - have fun but be responsible.

This Equine Facilitated Learning program is provided by State of NM Special Appropriations grant. Attendance is mandatory unless your child is ill. Surveys will be required before and after attendance to provide data the State of NM. All names will be redacted for reporting purposes. This twelve-week program will be two (2) 6-week sessions with a 2-week break in the middle. Holiday weekends will be considered in the schedule and attendance will not be required for holiday weekends. Page 4

We encourage families to make regular attendance a priority to gain the most benefit. If it is absence is necessary, such as illness, please notify Loving Thunder at least 24 hrs in advance. If a cancellation by Loving Thunder staff is necessary due to weather or other unforeseen circumstances, we will inform you of a reschedule accordingly. Loving Thunder will notify of weather cancellations no less than one hour before the scheduled lesson by phone.

I have read the current Attendance and Funding sheet and agree to make every effort to attend regularly.