HETRA Equine Services for Veterans Paperwork

Welcome!


Dear HETRA Participants or Caregivers,


Thank you for choosing HETRA.  We look forward to working with you this year!  Please read through all the information in this letter thoroughly.  It contains very important information regarding your registration and participation in the HETRA program.


We currently have openings in the Veterans program, but these spots fill up fast so get your paperwork in quickly!  If you need any assistance in filling out the paperwork, would like a private tour of the facility, or to talk more about the program please contact me directly.  We look forward to embarking on this adventure with you. 


Thank You!


Edye Godden

Edye Godden, OTR/L

Executive Director

www.hetra.org

edye@hetra.org

402-708-6433

Participant Handbook

1.  Getting Started

 

First please complete all paperwork included in this package.  Then either mail (HETRA, 10130 S. 222nd Street, Gretna, NE 68028) or fax (866) 577-4598 your completed paperwork in to HETRA.  Once you have completed your paperwork please contact Edye (402) 708-6433, to schedule your evaluation (new participants) or riding time (returning participants).  If you are a returning participant your reevaluation if needed will be completed during your first riding session.  All new participants need to schedule a separate evaluation.   

2.  Participant Dismissal & Discharge Policy

It is at the discretion of HETRA’s Executive Director and Program Director to accept or remove a participant from the program. The results of a risk/benefit analysis will also be considered. Participants who do not adhere to the rules and procedures or meet the guidelines for eligibility are subject to dismissal or discharge. Possible grounds for dismissal may include, but are not limited to: conduct endangering another participant or staff or the horse, conduct endangering themselves, consistent failure to follow safety procedures with respect to the horses, a gain in weight above the HETRA maximum levels, failure to cancel in advance for more than three lessons or incomplete paperwork. Paperwork that is required is: Registration / Health History/Photo Release, Authorization for Emergency/ Medical Treatment, Consent for Release of Information, Participant’s (Signed) Medical History and Physicians Statement, Policies, Procedures and Barn Rules Agreement.  The development of a contraindicated condition or the deterioration of a condition to the point horseback riding is no longer beneficial or could be harmful to the participant or where safety for the participant or others has become a concern.

 

Participants at HETRA shall have no history of inappropriate behavior with fire or any tendencies or history of abuse or violence directed toward other people or animals. HETRA reserves the right to deny services to any individual based upon concerns for the applicant’s safety and/or the safety of the horses, volunteers, staff, property owners, or for other reasons in accordance with PATH, Intl. operating center guidelines.

 

No participant will be dismissed without an opportunity to discuss the reasons with supervisory staff.  The participant may at any time, for whatever reason, decide to sever the participant relationship with HETRA. Notice of such a decision should be communicated as soon as possible.

 

3.  Weight Limitations for All Participants

 

Maximum weights are listed below, but decisions regarding participation will be based on the availability of a suitable horse related to the height, weight, cognition and balance of the participant.

  -  220 lbs. for a well balanced centered participants not requiring sidewalkers.

·                 -   180 lbs. for an unbalanced participant needing sidewalker assistance.

·                 -   Each horse has individual weight limitations based upon the horses height, weight, age and physical and medical condition. 

                   -   We are able to accommodate weights over the 220 range for ground or carriage driving lessons. 

 

4.  Scheduling of a weekly riding time for new participants 

Once the initial evaluation is completed we will make a program recommendation for you and then see if we have a current opening in the HETRA schedule that is suitable to meet your needs.  If an opening does not currently exist then we will put your participant on a waiting list and you will be notified as soon as an opening becomes available.  Riding sessions are offered late afternoon to evening on weekdays and mid day on the weekends, available riding times will be discussed at your evaluation. 

 

5.  Cancellations

  

You will be notified by phone, email and/or text message for weather cancellations.   

 

6.  ATTIRE

 

No open toe shoes, sandals, or clog type shoes.  No slick (jogging type) pants.  We would prefer that your participant wore pants instead of shorts as the saddle can get very uncomfortable with direct skin contact.

 

7.  CHILDREN

 

We ask that children be monitored and in direct vision of the adult at all times while at the facility.  Please review the barn rules with your children prior to arriving at the barn.  Please make sure there is another adult to supervise children during your HETRA sessions. 

 

8.  DOGS and OTHER ANIMALS

 

Do not bring dogs or other animals to the barn with you at anytime.  The exception to this rule is service animals.  Please let your Instructor know if you will be bringing a service animal to the session with you.

 

9.  QUESTIONS

 

Please direct questions to your Instructor.  If you do not get a satisfactory answer to your question please feel free to contact Edye at 402-708-6433. 

 

  

Thanks so much for your interest in our program, we look forward to working with you this year.  I can be reached and communicate best through email at edye@hetra.org.  I can also be reached at 402-708-6433.

 

Thank You!

Edye Godden

Executive Director, HETRA







Please enter none if not applicable














Mother/Guardian Information (minor or dependent adult only)












Father Information (minor or dependent adult only)












In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on the property of the agency, I authorize Heartland Equine Therapeutic Riding Academy to:

1. Secure and retain medical treatment and transportation if needed.

2. Release participant records upon request to the authorized individual or agency involved in the medical emergency treatment.

In the event I cannot be reached please contact: 

Emergency Contact #1



Emergency Contact #2










Participant Liability Release

Liability Release

 

(participant’s name above) would like to participate in the Heartland Equine Therapeutic Riding Academy program.  I acknowledge the risks and potential for risks of horseback riding.  However, I feel that the possible benefits to myself/my son/my daughter/my ward are greater than the risk assumed.  By entering my name below, 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 Heartland Equine Therapeutic Riding Academy, its Board of Directors, Instructors, Therapists, Aides, Volunteers, and Employees for any or all injuries and/or losses I/my son/my daughter/my ward may sustain while participating in Heartland Equine Therapeutic Riding Academy Programs.



Photo Release

to the use and reproduction by Heartland Equine Therapeutic Riding Academy of any or all photographs and any other audiovisual materials taken of me/my son/my daughter/my ward for promotional printed material, educational activities or any other use for the benefit of the program.



Medical Consent

This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed “life saving” by the physician.  This provision will only be invoked if the parent/guardian or emergency contact is unable to be reached. By entering your name in the signature box below you agree to the above statement Medical Consent Plan. 



Consent to Treat 

I hereby consent to evaluation by an occupational, physical or speech therapist prior to participation in HETRA programming.  If physical therapy, occupational therapy or speech therapy is deemed appropriate I give consent for treatment as outlined by the therapist. 

 

Date:_______________Signature_____________________________________________________________
                                                                    (Participant, Parent or Guardian)

  




Barn Rules

SAFETY RULES FOR ALL HETRA STAFF, VOLUNTEERS, FAMILIES AND PARTICIPANTS

 

The following guidelines have been developed for your safety. 

Failure to follow these rules can result in your dismissal from this facility.


  1. Please DO NOT pet the horses in any outside pens or indoor stalls.  Some horses on the property are privately owned and are not part of the HETRA herd.
  2. Please do not arrive at the barn before you are scheduled.  There must be a HETRA Instructor, Staff Member, or Barn Leader on site when volunteers, participants, or guests arrive.  For insurance purposes there cannot be visitors at the HETRA facility when there is not a staff member on site.
  3. ONLY the Barn Leader or certified Horse Leader will be allowed to get horses from outside pens.
  4. No individual should enter a pen or stall with a loose horse in it. 
  5. You should not be in any outside pens UNLESS you have been asked by an Instructor or Barn Leader to complete a specific task in this area.  Once this has been completed please return to the proper volunteer areas.
  6. NEVER sit, kneel, or lay on the ground near a horse. 
  7. All phones must be turned to silent or vibrate when in the arena.
  8. Please only use HETRA tack and equipment and always return it to its appropriate place.
  9. Always clean up after yourself and any horse you are working with (sweep up hair, manure and throw away any trash).
  10. All riders during a HETRA riding session are required to wear approved safety helmets (this includes Instructors).
  11. Please do not feed any horses treats.  Treating horses tends to promote biting.  Also some horses are on special diets and treats can be detrimental to their health.  Please do not allow horses to lick your hands, this encourages biting. 
  12. Please DO NOT pet the horses on their heads or faces, this is a personal space for them and can make them crabby.
  13. When approaching a horse, always consider the horse’s limited field of vision.  Horses cannot see directly behind or in front of them without moving their head.  Always approach a horse at the shoulder, speak to them as you approach, and then extend your hand and pat them on the neck or shoulder.  When moving around a horse, placing a hand on their hip as you move around them allows them to know where you are.
  14. Avoid sudden movements when around the horse.  This includes removing coats, raising arms suddenly, running,  jumping, climbing, etc.  Horses can spook easily, please keep this in mind at all times when around horses.
  15.  Please DO NOT reach into or a pet a horse through the bars.  If they can put their heads out it is ok to pet them.  Please respect that they may need down time and do not want to be petted.
  16. Only HETRA Instructors are allowed to put bridles on the HETRA horses.
  17.  Please do not bring dogs or any other animals to the barn (If you have a service animal please notify HETRA Staff).
  18. The cats are cute and fun to play with but they can bite and scratch.  Playing with cats is done at your own risk. 
  19. All children under the age of 12 must be DIRECTLY monitored by an adult at all times while on the property.
  20. DO NOT enter any other buildings on the property unless directed by a HETRA Instructor or Staff Member.
  21. If you are not directly involved with a session please keep all activities and conversations to the designated waiting areas or check with the Barn Leader or Schedule Keeper as to additional tasks that need to be done around the barn. It is important to keep noise and conversation to a minimum when lessons are being conducted as it can be very distracting for the participants and horses.
  22. The session Instructor is ultimately responsible for all aspects of the session from the time the first horse is taken out until the last one is put away.  Please listen and follow all directions given by the session Instructor.  Please be aware of all situations around you and report any unsafe situations to the session Instructor or Barn Leader immediately.
  23. HETRA strictly prohibits anyone, including individuals with permits, to carry concealed handguns, from possessing and/or carrying a concealed handgun while on HETRA’s property.  NO EXCEPTIONS will be made to this Policy.  Any violation may result in the dismissal of Volunteer or Guest.                                                          

    My Family and/or I have read the Barn Rules and by entering my name below I agree to follow them at all times while at the facility.


NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL AND PERSONAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION

 

PLEASE REVIEW THIS FORM CAREFULLY

OUR LEGAL DUTY

 

                Heartland Equine Therapeutic Riding Academy is required by law to protect the privacy of your personal and health information, provide notice about our information management practices, and follow the information protocols described below. 

 

USAGES AND DISCLOSURES OF HEALTH INFORMATION

 

Heartland Equine Therapeutic Riding Academy uses your personal and health information primarily for treatment, obtaining payment for treatment, conducting internal administrative activities, and assessing the quality of care we provide.  We use your personal information to contact you for scheduling, billing and providing organizational information.

 

Heartland Equine Therapeutic Riding Academy will obtain your written permission and authorization before disclosing your personal health information.  If you provide us with written authorization to release your information for any reason, you may later revoke that authorization to stop disclosures at any time.  If and when any changes are made in our privacy and confidentiality policies, a new Notice of Information Practices will be posted in the same area for public view.  You may request a copy of our Notice of Information Practices at any time.  Our HIPAA Compliance Officer is Edye Godden and can be reached by calling the office at (402) 359-8830. 

 

PATIENTS INDIVIDUAL RIGHTS

 

You have the right to review or obtain a copy of your personal health information at any time.  You have the right to request that we correct inaccurate or incomplete information in your records.  You also have a right to request a list of instances where we disclosed your personal health information for any reasons other than for treatment, payment, or other related administrative purposes.

 

You may request in writing that we not use or disclose your personal health information for treatment, payment or administrative purposes except when specifically authorized by you, when required by law, or in an emergency.  Heartland Equine Therapeutic Riding Academy will consider all such requests on a case-by-case basis.  The company is not legally required to accept the requests.

 

CONCERNS AND COMPLAINTS

 

If you are concerned that Heartland Equine Therapeutic Riding Academy may have violated your privacy right or if you disagree with any decisions we have made regarding access or disclosure of your personal health information, please contact our HIPAA Compliance Officer, Edye Godden, at the office address listed below.  You may also send a written complaint to the U.S Department of Health and Human Services. 

 

Heartland Equine Therapeutic Riding Academy

HIPAA Compliance Officer

Edye Godden

10130 S. 222nd Street

Gretna, NE 68028

Phone: (402) 359-8830





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