Healing Hoof Steps Adaptive Riding Application

Dear Prospective Healing Hoof Steps Therapeutic Riding Participant,

Thank you for your interest in Healing Hoof Steps Therapeutic Riding Program. Enclosed you will find general information on our programs, the application process, and the required paperwork. Once all the completed forms have been received by our office, you will be contacted to schedule a pre-session assessment if you are new to Healing Hoof Steps. Returning participants don’t have to go through another assessment unless there has been a significant gap in time participating in any of our programs. Following the assessment, you will be added to our participant list and the information you provide on the enclosed forms will assist us with scheduling and determining the goals and matching the appropriate portion of the program. Please know that we do all that we can to integrate participants whenever possible. Many of our participants return each year/semester and openings are limited. Program openings are based on the availability of resources so when an opening becomes available, you will be contacted to schedule enrollment into the program. Completion of this application allows us to determine eligibility of each participant to ensure that all safety guidelines met prior to enrollment into our program. The completion of the application does not guarantee enrollment. Additional openings in the schedule can sometimes allow us to host group activities. We typically would not exceed a group of 10 participants at one time but on rare occasions with diligent planning and correct resources, we might be able to accommodate. Group activities may involve some riding but will involve unmounted, ground activities as described below: Equestrian Skill Standards: Equestrian Skill (ESK)-Services are services where the goal or outcome for the participant is to gain a horsemanship skill. These skills may be in the area(s) of riding or ground skills. Equine-Assisted Learning (EAL)- is an area of non-therapy services comprised of equine-assisted learning in education, equine-assisted learning in organizations, and equine-assisted learning in personal development. Specially trained or certified professionals provide these services to engage people of all ages in learning processes that are focused on leadership skills, character-building skills, and academic skills, among other relevant life skills. Horsemanship – is an area of non-therapy services adapted from traditional disciplines of horseback riding for individuals or groups with diverse needs. Equine professionals with specialty training or certification provide these services by developing lesson plans that may involve riding or ground-based activities such as grooming, handling, leading, observing and other readiness activities. Should you have any questions, regarding the application process, enclosed forms, or would like to arrange a visit or check on your status, please contact us at (850) 764-1005. Sincerely, Narissa Jenkins CEO and Founder

Each form must be signed by the appropriate party. Note- our Physician’s Release Form must be signed by a physician. Once all forms have been received, you will be contacted for a pre-session assessment. Following the assessment, the prospective participants will be placed on the Participant List.

Scheduling/Sessions: Length of session varies by season
See current Session Calendar for specifics. Healing Hoof Steps offers several sessions per year mostly in the Winter, Spring, and the Fall. Each lesson is 50 minutes in length based on the individual’s needs and scheduled availability. Lessons may be private or semi-private (groups of 2 or more, usually, participants with similar goals are grouped together). Lessons are scheduled for the same day and time each week for the length of the session. Holidays: Refer to current Session Calendar for holiday closures.

Fees & Payment Policy
Therapeutic Riding/Mounted activities: $55.00 per lesson (session length may vary).

Group activities of 5 or more: $25 per participant for 90 minutes of a variety of activities.

Payment Options: Cash pay, Step Up For Students (formerly Gardiner Scholarship), Sunshine Medicaid Expanded Benefit Members, Air Warrior Courage Foundation (active duty dependents only) or United Way Scholarship

Payment Policy:

1. Healing Hoof Steps expects payment to be made in full, on or before, the first lesson of each term.

2. Full session fee applies regardless of number of times present for scheduled lesson time. Participants will be responsible for payment of missed lessons unless it is canceled by Healing Hoof Steps

3. Any participant that has an account 45 days past due will not be able to ride until his/her account is brought current. No exceptions. Scholarships: Healing Hoof Steps partners with various individuals and companies to give scholarships to individuals in financial hardship. Please contact our office for information about scholarships.

Annual Paperwork, Guidelines & Policies
Healing Hoof Steps maintains required participant paperwork on a bi-annual basis. This ensures Healing Hoof Steps has the most current information on file for all participants. New Participant Applications, or a Rider Renewal Form will be distributed at the beginning of each year with a deadline. A participant’s services/session may be put on hold if it this paperwork is not complete. Weight & Age Guidelines: Horse selections are based on upon safety, the horse’s size, build, age, temperament, lesson objectives, etc. Participants must be age 5 or older and as of right now must not exceed a weight of 225 pounds or more but this can depend on rider’s balance and coordination. Punctuality: It is important for a participant to arrive on time for their lesson. If you are running late please contact the Healing Hoof Steps office at 850-764-1005. If the rider does not show up within 15 minutes of the scheduled time their horse will be put away and volunteers dismissed. Attendance: Healing Hoof Steps expects consistent attendance by all participants. Due to our schedule and limited resources, there are no make-up opportunities for missed lessons unless Healing Hoof Steps cancels classes due to some unforeseen circumstance such as instructor absence or severe weather. At that time, all reasonable attempts will be made to notify participants at least two hours prior to the change. 1. If you are unable to attend a regularly scheduled lesson, notification must be made by calling Healing Hoof Steps at 850-764-1005 as soon as the absence is anticipated so we may provide enough notice to staff and volunteers. 2. Two (2) cancellations in a session OR five (5) cancellations per calendar year could result in the loss of your scheduled appointment time and/or scholarship.

I have read and acknowledge the paperwork, guidelines & polices. 

Weather Policy
While we make every effort to hold mounted lessons, the following are examples of when unmounted lessons will be used as substitute (if mounted lesson is inappropriate for a participant, then the lesson would be cancelled all together). 1. In the event of a national weather service warning for Okaloosa or Walton Counties 2. If there is thunder and/or lightening within 10 miles of the facility. 3. If “real feel” temperature exceeds 100 degrees or is below 32 degrees. 4. Sustained winds of 15 mph or higher In the event of a lesson cancellation due to inclement weather, Healing Hoof Steps will make every attempt to notify the participant or their guardian. It is the responsibility of the participant to ensure that Healing Hoof Steps has a current phone number and/or email address for participant notifications.

Required Attire for Riders
1. ASTEM/SEI approved helmet (will be provided by Healing Hoof Steps) 2. Closed- Toe shoes or boots, preferably with heels and can be tied well for stability 3. Long pants or knee length shorts (slippery sport pants are not appropriate for riding) 4. Jackets are required for cold weather

I have read and acknowledge the required attire for riders.

Family, Friend and Conduct
Friends and family are always welcome to come watch their rider/participant. All visitors will need to remain in the parent viewing area while the rider is in their lesson. If siblings are in attendance with parents or guardians of the participant, they are responsible for direct supervision at all times. Noise and disruptive activity in the parent viewing areas can and may distract horses and participants and can be a safety issue. Conduct While at Healing Hoof Steps: It is important that everyone complies with all posted safety rules; therefore, obey all posted off limit areas. Healing Hoof Steps is a “no smoking” facility and the use of drugs, alcohol on the property is strictly forbidden. No mistreatment or abuse of any person or animal will be tolerated.

I have read and acknowledge the family, friends and conduct policy.

Healing Hoof Steps Statement of Participant Eligibility or Dismissal
Healing Hoof Steps, Inc. offers services to individuals with diverse needs. In order to participate in any mounted activities at our Therapeutic Riding Program, individuals must: • Possess a diagnosis from or by a professional (physical, cognitive, emotional, or behavioral) • Physically able to sit symmetrically with torso upright and legs astride the horse during movement • Physically able to maintain head and neck position independently in proper alignment within movement • Does not exhibit physical or behavioral conditions that are contraindicated by PATH Intl (Staff at Healing Hoof Steps can discuss contraindications with participants/guardians) • Able to tolerate wearing a riding helmet • Ability to accommodate the movement of the horse without pain • Adequate range of motion in hip(s) to sit astride a horse • Safety awareness around animals • Ability to express pain and discomfort • Behave in a manner that is safe for self, horses, and others Financial consideration is not considered in determining the eligibility for participation. As a PATH Intl. center member, Healing Hoof Steps follows the Precautions and Contraindications as recommended by the Medical Committee of PATH Intl. as well as Professional Standards. Therefore, our professional staff provides initial and ongoing evaluations for all prospective and active participants. As a result of unusual occurrences during a program session, the Healing Hoof Steps staff may find that continuance in the program for a given individual is inappropriate. For this reason, Healing Hoof Steps reserves the right to discontinue the participation of an individual in its programs when it is deemed that the discontinuance is in the best interest of Healing Hoof Steps and/or the individual concerned. Healing Hoof Steps reserves the right to decide if we are unable to serve an applicant due to unavailable resource(s) and/or safety concern including PATH Intl. guidelines relating to contraindications for participation.

Parent Information
Please adhere to the following so that the Healing Hoof Steps facility/barn remains a safe and enjoyable area for everyone: 1. All children who come to Healing Hoof Steps are the responsibility of the adult with whom they arrive. For safety, all children who are not participating in a therapeutic riding lesson or equine assisted activity must be supervised and remain inside the parent viewing area. CHILDREN WAITING FOR THEIR LESSON TO BEGIN MUST ALWAYS BE SUPERVISED UNTIL THE INSTRUCTOR INDICATES IT IS TIME FOR THE LESSON/ACTIVITY. We appreciate your understanding that distractive activities such as ball tossing, running and Frisbee cannot take place outside, while lessons/sessions are happening. 2. No running, yelling or loud voices are permitted in the barn, unless under the instruction of a staff member during a session. 3. No flash photography is permitted unless you first check with instructor. We ask that no parents or guardians be in the arena area while a lesson/session is in progress. We ask that if you would like to take photos of your child during a lesson/session that you contact the office ahead of time. Additionally, parents can request photos that are taken of their rider be sent to them via email. 4. No smoking is permitted inside or outside the barn. 5. Please call 850-764-1005 if you will be late for your scheduled lesson/session or need to cancel and/or reschedule. 6. The dress code for Healing Hoof Steps Participants engaged in EAL is: T-shirt or short sleeve shirt, jacket in the cool weather, knee length shorts (during the summer) or jeans and must be of non-slippery fabric and CLOSED TOE SHOES AND CLOSED HEEL SHOES that can be tied well for stability. A participant arriving with sandals or flip-flops will not be allowed to enter the area where horses are present. 7. The Healing Hoof Steps instructor(s) reserve the right to modify a participant’s lesson and program within the instructor’s scope of practice, in order to ensure the safety of the participant, the staff and the horses. Any modifications or plan changes will be based on the instructor’s professional judgment. The head instructor will determine whether an appropriate horse and staff are available for each participant applying for Equine Assisted Activities. If a rider exhibits temper tantrums, frustration, or agitation while in the presence of a horse, the head instructor will assist the participant to transition to an alternate Equine Assisted Activity.

I have read and understood the above and agree to adhere to the safety rules 

Please select “Yes” or “No” to indicate if participant has diagnoses, issues, or concerns in the following areas. If you select “Yes”, please describe.

PERSON TO CONTACT IN CASE OF AN EMERGENCY

I/my son/my daughter/my ward would like to participate in an equine related activity at Healing Hoof Steps Inc. I acknowledge the risks and potential for risks of riding lessons and horse related activities. However, I feel that the possible benefits to myself/my son/my daughter/my ward are greater than the risk assumed. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors, or administrators, waive and release forever all claims for damages against Healing Hoof Steps, Inc. and its Employees, Instructors, Therapists, Aides, Volunteers, Equines, Equine Owners, Equipment and Operating Site for any and all injuries and/or losses I/my son/my daughter/my ward may sustain while participating at Healing Hoof Steps, Inc. 1. RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Healing Hoof Steps., its operators, horse owners, and each of them, their officers, agents, employees, leasees, volunteers and participants (all hereafter collectively referred to as REALEASEES) from any and all claims, loss, damage, and liability to the UNDERSIGNED, his/her personal representatives, assigns, heirs, next of kin, or anyone claiming through them, arising out of any liability or negligence of RELEASEES which causes the UNDERSIGNED injury, death, damages, or property damages. I HEREBY COVENANT to hold RELEASEES harmless and indemnify RELEASEES for any claim, judgment, or expense including attorney’s fees and costs of litigation RELEASEES may incur arising out of my activities or presence, or travel to or from, at or on the farm, including the playground, or on the property of RELEASEES or at horse shows. 2. that my entry onto the farm or premises of RELEASEES, riding, showing, or attending horse shows involves DANGER AND RISK OF INJURY OR DEATH, that conditions of horseback riding and horses change from time to time and may become more HAZARDOUS, and that there is INHERENT DANGER in horse and riding which I appreciate and VOLUNTARILY ASSUME because I CHOOSE TO DO SO. I have observed horses and riding of the type that I seek to participate in and I have inspected the grounds, horse, and equipment provided. I further know that other riders, horses, and participants pose a danger to me; nevertheless, I VOLUNTARILY ELECT TO ACCEPT ALL RISKS connected therewith in my participation. Likewise, I understand that use of the playground and playground equipment is voluntary and that use of the equipment involves DANGER AND RISK OF INJURY OR DEATH. I have personally inspected the playground and VOLUNTARILY ELECT TO ACCEPT AND ASSUME ANY AND ALL RISKS connected therewith in my participation and the participation of my child or children. 3. I verify that no representations or inducements have been made to me to sign this Release. I further expressly agree that the foregoing RELEASE, WAIVER, AND INDEMITY AGREEMENT is intended to be as broad and inclusive as permitted by the law of the state in which I participate in activities conducted by the RELEASES and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect.

WARNING: Under Florida Equine Liability law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to Chapter 773 of the Official Code of Florida Annotated. THE UNDERSIGNED HAS READ, VOLUNTARILY SIGNED, AND UNDERSTANDS THAT THIS RELEASE AND WAIVER OF ALL LIABLITY AND INDEMITY AGREEMENT FULLY RELEASES HEALING HOOF STEPS FROM ANY LIABILITY TO THE UNDERSIGNED.