• HARMONY HORSEMANSHIP

    HARMONY HORSEMANSHIP

  • Individual Consent Form CONFIDENTIAL

  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year

  • Details of Proposed Activity – The Horse Course (THC)

  • You and/or your child are invited to participate in activities in farm environment, specializing in horsemanship. For the purposes of this document we will refer to you or your child as 'The Participant'. For horsemanship activities that will take place on the ground (unmounted). We have a round pen and obstacles outside where we will hold sessions. There is limited shade and shelter. Please wear weather appropriate clothing to be outside. In warm weather, please don't forget sunscreen, hats and bug spray. In cold weather, please be sure to dress warmly with hats, coats, and gloves.

  • Place

  • The activity will take place either at Harmony Horsemanship's headquarters or at one of their partner facilities. Please call 423-451-6328 if you have questions or have trouble finding us.

  • If you are bringing a young person (under 18yrs) please wait until a facilitator is with them before leaving the site.

  • Acknowledgment of Risk

  • Horsemanship events may pose additional risks to those encountered during a normal day. We have assessed the risks to participants and believe that the planning undertaken and systems to control and manage the risks have reduced the chance of harm to an acceptable level. We have appropriate insurance, you may wish to arrange your own additional insurance.

  • Safety

  • Medical

  • Privacy Notice

  • The Horse Course controls data in accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Privacy Act of 1974. The purpose of this form is to obtain your consent as a participant (or their parent/guardian for minors) to take part in the proposed event and for our ongoing use of data as specified below. Our Data Protection Policy is available on request, detailing retention periods and rectification processes. You can ask to see, correct or delete your data at any time. We will never sell your data or share it with anyone for the purpose of sales or marketing. We do need to share your personal data (including health data) with referring / relevant professionals. We store data for 5 years in case participants are re-referred to our service.

  • Consent for Activity

  • I confirm that the participant is in good health and fit to participate and agree to inform the staff if that changes. I understand that whilst every reasonable care will be taken, the service and its staff cannot be held responsible for damage to or loss of property whilst taking part in this activity. I give consent for the participant to:
  • 1. Participate in the activities of this program.
  • 2. Receive emergency medical treatment if necessary.
  • 3. Travel by any motor vehicle driven by a suitably qualified person at the discretion of staff.
  • 4. Follow any rules and instructions given by staff.
  • 5. For a referral to the Multi Agency Safeguarding Hub / other appropriate agencies to be made as appropriate.

  • Photos and Videos

  • I consent to The Horse Course taking, storing and sharing photos or video of the participant for the following purposes:
  • 1. To produce prints or digital photos for me to be sent to my email address.
  • 2. To take and store video for horsemanship assessment.
  • 3. For promotional/training/ publicity purposes. Photos/videos may be used by Harmony Horsemanship in print or digital form, including on social media in compliance with our media policy.

  • Use of data

  • I consent to Harmony Horsemanship collecting, processing, storing and sharing personal data (including health info) about the participant for the following purposes:
  • 1. To share case notes with my referral/care professionals.
  • 2. To retain and analyze case notes for quality, monitoring and evaluation purposes.
  • 3. For The Horse Course or University researchers to contact me for further follow up.
  • I am happy to receive marketing, fundraising emails, and progress reports from
  • 1. The Horse Course (International):
  • 2. Harmony Horsemanship:
  • Format: (000) 000-0000.
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  • Should be Empty: