PETRA Rider Registration Package

Rider Registration Package
Performance Equestrian & Therapy Riding Academy (PETRA)
All clients complete Sections 1, 2, and 3 (this form).

Therapeutic riding clients: please also complete the separate Therapy Client Supplemental Information form.
SECTION 1 — CLIENT CONTACT INFORMATION
PETRA does not share any of your information with anyone, unless you provide explicit written permission.
Client Information
Name*

First NameLast Name
Email*
example@example.com
Mobile Phone*
Format: (000) 000-0000.
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian / Caregiver Information
Complete this part if client is under 18 or has a permanent caregiver.
Name*

Parent/guardian First NameParent/guardian Last Name
Relationship to Client
Parent/guardian Email*
example@example.com
Parent/guardian Mobile Phone*
Format: (000) 000-0000.

SECTION 2— MEDICAL & EMERGENCY INFORMATION
Primary Physician
Physician Name*
Phone*
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My physician has cleared me for equine-assisted activities. PETRA does not require this, but we ask for our records.
Health Insurance
Insurance Company
Phone
Format: (000) 000-0000.
Name of Insured
Who is the sponsor or holder of your health insurance policy? If you are the sponsor, then please retype your name here.
Policy Number
Allergies
List any allergies, or write "None":*
Severe Allergic Reactions
Have you been prescribed an Epi-Pen (epinephrine auto-injector device) by a doctor?*

YesNo
Medications
List current medications including dosage and frequency, or write "None":*

Emergency Contact
Name*

Emer contact First NameEmer contact Last Name
Emergency Contact Phone*
Format: (000) 000-0000.
Emergency Contact Relationship to Rider
Emergency Medical Treatment Authorization
In the event of a medical emergency, please select ONE of the following:*

I CONSENT - I authorize PETRA to secure medical treatment and transportation if needed, and to release participant records to any agency involved in emergency treatment. This includes x-ray, surgery, hospitalization, medication, and any life-saving procedures. This applies only if I cannot be reached.I DO NOT CONSENT - I do not authorize emergency medical treatment. I agree to remain on-site at all times. In an emergency, I wish the following to occur:
Signature*

Signature of parent or guardian if under 18
Print Name*
Date*

MonthDayYear
Date

SECTION 3 — POLICIES & RELEASES
Release & Hold Harmless Agreement
WARNING: VIRGINIA LAW
Under Virginia law (Code of Virginia § 3.2-6200 et seq.), 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 intrinsic dangers of equine activities, including: (i) the propensity of equines to behave in ways that may result in injury or death; (ii) the unpredictability of an equine's reaction to sounds, movement, or unfamiliar objects; (iii) surface and subsurface hazards; (iv) collisions with other animals or objects; and (v) negligent acts by the participant.
In consideration of receiving permission to participate in or observe equine-assisted activities at PETRA, and to enter upon PETRA's property, the undersigned and his/her family, heirs and assigns forever release, discharge and hold harmless PETRA, its officers, staff, agents, instructors, volunteers, contributors, and any affiliated property or horse owners from any and all liability, claim, loss, damage, illness, injury, or death sustained while on the premises, participating in or observing activities, or traveling to or from the premises.
The undersigned acknowledges the inherent risks of equine activities including unpredictable animal behavior, equipment failure, and surface hazards. While PETRA makes every effort to minimize these risks, the undersigned knowingly assumes them and agrees to communicate these risks to any accompanying persons, who also assume the same risks by their voluntary presence.
The undersigned further releases PETRA and all affiliated parties from any liability, including attorney's fees, arising from the improper or negligent use of any equine, equipment, or tool, or from the willful or negligent acts of the undersigned.
Signature*

Signature of parent or guardian if under age 18
Print Name*
Date*

MonthDayYear
Date

Policies & Procedures
Please read each policy carefully. Sign and date at the bottom.
1. Registered Rider Scheduling & Payments
- PETRA is a registered rider program: this means we seek disciplined students who commit to riding regularly. Habitual riding contributes to safety, horsemanship excellence, and personal growth. Regular riding also curates our horses so they're safe, well-conditioned, and healthy.
- All completed forms are required before the first session.
- PETRA requires a paid riding assessment prior to enrollment to determine appropriate horse, tack, and support needs.
Cancellations & Rescheduling:
- Emergency cancellations (illness, family emergencies, etc.) — call your instructor at the number they provide you on Lesson 1.
- Non-emergency: Call/text your instructor no later than 48 hours prior to your scheduled lesson time. Within 48 hours of your scheduled lesson, we must deduct that lesson from your remaining available lessons for the month.
- Rescheduling: Coordinate with your instructor to reschedule a maximum of one lesson per month. *We understand life happens. Please discuss rescheduling with your instructor.
- You will have 30 days from the missed lesson to complete a rescheduled lesson.
- Weather & PETRA operational rescheduling: Please check the weather prior to your lesson and contact your instructor with questions. In the case of inclement weather, emergency instructor absence, holidays, or other contingencies, your PETRA instructor or staff will contact you. We will accommodate your schedule to make up missed lessons within a 30-day time limit.
- Payment methods: Zelle (Zelle code: “petrapay” enrolled under J2i Partners LLC), Venmo (@Jaime-Santucci), cash, or check (made out to PETRA).
- PETRA does not bill insurance companies. If your insurance covers equine therapy, you will need to pay PETRA directly and seek reimbursement from your provider. We can provide invoices & receipts upon request.
2. Arrival
- Please arrive at least 20 minutes before your scheduled session.
- Late arrivals may forfeit their session, as disruptions affect all riders in the lesson.
- Please drive slowly on all farm roads and parking areas, and remain alert to horses, people, and animals.
3. Attire
- ASTM/SEI certified riding helmet required (manufactured within the last 5 years).
- Long pants required — riding tights or stretch pants preferred; slippery athletic pants are not recommended.
- Close-toed shoes with a heel required. Crocs and flip flops are not permitted.
4. Health & Safety Updates
- Please notify PETRA immediately of any changes to the client's health, medications, or physical condition. Current information is essential for safe and effective instruction.
- Keep your contact information up to date so we can reach you promptly.
- If you have been prescribed an Epi-Pen by a doctor, please carry it on your person during your time at PETRA (or on the person of your parent/guardian who will accompany you the entire lesson).
5. Age & Weight
- Maximum client weight is 200 lbs. Please contact us if this applies.
- Clients must be at least 6 years old. There is no maximum age limit.
- Each client is individually evaluated — weight eligibility alone does not guarantee suitability for riding.

6. Visitors
- Siblings and guests must remain in designated areas and be supervised by an adult at all times.
- Please keep noise to a minimum. Balls, frisbees, or similar items are not permitted near the arena.
- Smoking, drugs, and alcohol are prohibited on the property.
- No dogs allowed on the property, with the exception of ADA-recognized service animals with prior permission.
7. Grounds for Dismissal
- PETRA reserves the right to decline services for any reason, including but not limited to:
- A change in condition that is now considered a contraindication for riding.
- Unsafe behavioral, physical, or emotional changes.
- Exceeding the weight limit.
- Excessive no-shows or late arrivals without notice.
- Being under the influence of drugs or alcohol.
- Any circumstance where continued participation is deemed inappropriate by PETRA staff.
- Any unused lesson or session fees will be refunded.
I have read and agree to abide by PETRA's policies.
Signature*

Signature of parent or guardian if under 18
Print Name*
Date*

MonthDayYear
Date

News & Photo Release
PETRA occasionally uses photographs and video of participants to promote equine-assisted activities and therapies through media including social media, brochures, and instructional materials. No images will be used for commercial purposes, and no names will be used.Please select one:*

I DO grant permission - I grant permission for PETRA to photograph/film my child/ward/self and use those images for the purposes described above.I DO NOT grant permission.
Signature*

Signature of parent or guardian if under 18
Print Name*
Date*

MonthDayYear
Date
Should be Empty:

Rider Registration Package

SECTION 1 — CLIENT CONTACT INFORMATION

Client Information

Parent / Guardian / Caregiver Information

SECTION 2— MEDICAL & EMERGENCY INFORMATION

Primary Physician

Health Insurance

Allergies

Severe Allergic Reactions

Medications

Emergency Contact

Emergency Medical Treatment Authorization

SECTION 3 — POLICIES & RELEASES

Policies & Procedures

1. Registered Rider Scheduling & Payments

2. Arrival

3. Attire

4. Health & Safety Updates

5. Age & Weight

6. Visitors

7. Grounds for Dismissal

News & Photo Release