Adaptive Riding Annual Renewal Participation Form - (9/2022)

Applicant Informaiton















Personal Health Information
















Availability
Please check all that apply




Parent/Guardian Information










Medical Emergency Contact Information
In the event of a medical emergency, TROT will provide basic first aid and/or call 911 and will disclose all available health care information to emergency medical personnel.








Reasons for Discharge
Please be advised of the following reasons that may lead to discharge from the adaptive riding program and/or the center.
1) The client has reached all of their goals and is ready to graduate.
2) The client's potential to maintain head and neck control while riding presents a safety concern.
3)The inability to follow directions is interfering with progress towards goals. 
4) Uncontrolled and/or inappropriate behavior that constitutes a safety risk to a client, staff, volunteer, and/or horse.
5) The client exceeds weight staff, volunteers, and/or horses can safely manage.
6) Any change in the client's medical, physical, cognitive, or emotional condition that makes adaptive riding inappropriate.
7) Three scheduled appointments are missed without prior cancelation.
8) Disruptive behavior that is counterproductive to the benefit of anyone, equine or human at TROT.
9) Any purposeful act of compromised safety related to any equine, human or self at TROT. 
10) No longer suited, willing or able to preform activities at TROT safely or as directed.
11) Non-payment of fees, as originally agreed.

Procedure:
a) All participants/volunteers/guests who meet the criteria of dismissal will be asked to meet with the Volunteer Coordinator and Program Director to discuss the behavior/issue in question.
b) The Volunteer Coordinator and Program Director will work to educate and outline the appropriate expected behavior of the participant/volunteer/guest at TROT. 
c) If the participant/volunteer/guest is willing to perform the expected behavior/task, then support and further education will be implemented by the TROT staff.
d) If the participant/volunteer/guest is not receptive to the expectation of behavior, the volunteer will be asked to leave the TROT program. Therefore, the participant/volunteer/guest will be asked to leave the TROT property and banned from returning in the future without permission.
e) The participant/volunteer/guest will be sent a signed, dated letter confirming the expected actions as a result of the meeting. 
f) An additional copy of the letter will be Printed and placed in the participant's/volunteer's file. 

Participant Liability, Confidentiality Agreement, Photo and Video Release
Liability Release: I acknowledge the risks and potential risks for horseback riding and activities in and around a facility where horses are kept, and farm machinery operated. However, I feel that the possible benefits to me/child/my ward are greater than the risk assumed. Intending legally to bind myself, my heirs, and assigns, executors or administrators, I hereby waive and release forever all claims for loss or damages of any kind against TROT, its Board of Director, Instructors, Therapists, Aids, Volunteers and Employees for al and all injuries and losses that I/my child/my ward may sustain while participating in the TROT program. This release includes without limitation the risk of negligent instruction and supervision. I engage in activities at TROT voluntarily with knowledge of the risks and I assume all risks of injury, death, and property damage that may result. I agree to bear any loss myself. I acknowledge that TROT and the property owners are materially relying on this waiver and assumption of risk allowing me/my child/my ward to participate in activities at TROT. 

Confidentiality Agreement: I understand that all the personal information (written and verbal) about participants at TROT is confidential and not to be shared with anyone without expressed written consent of the participant of their parent/guardian if a minor. 

Photo and Video Release: The use and reproduction by TROT of any audio/visual materials taken of me/my child/my ward for distribution to the public for promotional printed materials, educational activities or for any other use for the benefit of the program. 

Contact Information