HETRA Unmounted Participant Paperwork

Welcome!

Dear Parents, 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 registration of your participant and participation in the HETRA program.


In order to keep the program affordable to all of the participants, HETRA continually hosts fundraising events and activities and looks for grants and foundations to help support our program.   HETRA continues to be committed to provide services to our participant regardless of their financial situation or ability to pay.  With this commitment though, we need help from all of our HETRA families to assist with our fundraising efforts throughout the year.


We are very proud of our dedicated and motivated parents and all that you do for the HETRA organization.  You are a very important part of our Team!!!!  We are looking forward to embarking on an adventure with you this year. 

Thank You!

Participant Handbook

1.  Getting Started

 

First please complete all paperwork included in this package.  Once you have completed your paperwork the HETRA staff will contact you, to schedule your evaluation.  


2.  Participant Dismissal & Discharge Policy


It is at the discretion of HETRA 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.  Scheduling   

Once the initial evaluation is completed we will make a program recommendation for your participant and then see if we have a current opening in the HETRA schedule that is suitable to meet your participants 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.  


4.  Billing

  • Life Skills: the fees for this program are $20 per daily session and billed at the beginning of the 12 week course. 

  • Equine-Assisted Learning or Mental Health Small Group - (3 or fewer participants): $40 per session, $480 for one 12-week course, a 10% early payment deduction is available if full payment is made by the due date posted on the invoice.  GAP is billed at the beginning of each 12-week course, and is due by the due date on the bill.  

  • Equine-Assisted Learning or Mental Health Large Group – (4+ participants): $20 per session, $240 for one 12-week course, a 10% early payment deduction is available if full payment is made by the due date posted on the invoice.  GAP is billed at the beginning of each 12-week course, and is due by the due date on the bill. 

  •  Equine-Assisted Learning or Mental Health Services (private): $35 for each 15-minute session, $70 for a 30-minute session, and $105 for a 45-minute session.  Every participant will be invoiced for a Course Fee at the beginning of the 12-week session in the amount of $300.  Then all completed Therapy Services sessions will be billed on a bi-weekly basis in the amount of $22.50 for each 15-minute session or $45 for each 30-minute session completed. Payment is due by the due date posted on the invoice.  Course Fee refunds will not be given for any Participant cancellations.  If HETRA cancels a session a refund of $25 per cancellation will be applied to your next invoice.   A 10% early payment deduction is available if full payment is made by the due date on the bill. 

  • Registration Fee:  A annual $35 registration fee is charged at the time the participant returns for sessions.

Any participant (in any program) with an outstanding balance from the previous course will not be allowed to ride until the balance on the account has been paid, payment arrangements have been made or scholarship forms have been filled out.   In addition, all participant fees that are not paid according to the previous payment arrangements, will be assessed a minimum of $20.00 charge per month (beginning once the invoice has gone over 30 days) to cover administrative expenses on the balance. 

 

5.  Cancellations

 

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


       Participant tardiness:  Any time a participant is late their session time will be decreased accordingly in order for the schedule to remain intact.  

      

        Dropping out of a session:  If a participant drops out prior to the end of a 12 week session, there will be a $50 charge assessed, if not medically necessary.  

 

6.  Scholarships

 

HETRA offers partial scholarships to all those who need them.   Scholarship levels will be approved according to the federal poverty guidelines.  If you do not qualify for a discount based on the guidelines but still need assistance please contact Erin Bevington, we will be happy to work with you.  We also ask that all parents/families that are able to participate in the scholarship program assist during the year with 1-2 fundraising activities that help keep the program affordable to all of our participants, and provide a minimum of 4 volunteer hours per 12 week session.  We will provide a discount form at your request during the initial evaluation along with a list of volunteer activities for your review (these will include activities that can be completed at the barn or at home).  


HETRA has also instituted a discounted services plan for those that help to raise funds for HETRA or those that volunteer for HETRA.   We do have a list of other community resources that may assist with the cost of the program for your participants.  We do ask that you follow up with these resources if you are in need of discounted services or a scholarship first and if you are denied at this level then we will assist you through the HETRA scholarship program.

 

7.  ATTIRE

 

No open toe shoes, sandals, or clog type shoes.  No slick (jogging type) pants.  

 

8.  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.

 

9.  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.

 

10.  QUESTIONS

 

Please direct questions to your participant’s Instructor.  If you do not get a satisfactory answer to your question please feel free to contact us at (402) 359-8830.




Please enter none if not applicable
















Military Information





First Responder Information


Primary Parent/Guardian (minor or dependent adult only)













Secondary Parent/Guardian (minor or dependent adult only)













Guardian Information (if different from above)













HETRA Billing Policy

If you have any questions about HETRA’s fees or billing
please contact Erin Bevington at Erin@HETRA.org.


To help HETRA save on postage, all invoices are sent via email.  

If you do not have an email or would prefer to receive your billing via regular mail, please let us know!

Fee Structure

HETRA does not bill health insurance or Medicaid


Life Skills Sessions: $20 per session, $240 for one 12-week course, a 10% early payment deduction is available if full payment is made by the due date posted on the invoice.  This program is billed at the beginning of each 12-week course, and is due by the due date on the bill. 

Evaluation: Evaluations are performed by one of the HETRA therapists for new Participants entering the program. Evaluation fees are $100.

Equine-Assisted Learning or Mental Health Small Group - (3 or fewer participants): $40 per session, $480 for one 12-week course, a 10% early payment deduction is available if full payment is made by the due date posted on the invoice.  GAP is billed at the beginning of each 12-week course, and is due by the due date on the bill. 

Equine-Assisted Learning or Mental Health Large Group – (4+ participants): $20 per session, $240 for one 12-week course, a 10% early payment deduction is available if full payment is made by the due date posted on the invoice.  GAP is billed at the beginning of each 12-week course, and is due by the due date on the bill. 

Equine-Assisted Learning or Mental Health Services (private): $35 for each 15-minute session, $70 for a 30-minute session, and $105 for a 45-minute session.  Every participant will be invoiced for a Course Fee at the beginning of the 12-week session in the amount of $300.  Then all completed Therapy Services sessions will be billed on a bi-weekly basis in the amount of $22.50 for each 15-minute session or $45 for each 30-minute session completed. Payment is due by the due date posted on the invoice.  Course Fee refunds will not be given for any Participant cancellations.  If HETRA cancels a session a refund of $25 per cancellation will be applied to your next invoice.   A 10% early payment deduction is available if full payment is made by the due date on the bill. 

Registration Fees: All Participants will be billed an annual $35.00 registration fee which helps HETRA cover insurance and other office fees. 

Any Participant with an outstanding balance from the previous course will not be allowed to participate until the balance on the account has been paid, payment arrangements have been made or scholarship application completed.   All Participant fees that are past due by 30+ days or are not paid according to the previous payment arrangements, will be assessed a minimum of $20.00 charge per month.

Financial Assistance
Scholarships and outside funding is available for all Participants in any program.  We can provide you with a list of outside funding sources that have been very supportive of HETRA families.  We ask that you investigate these options prior to applying for a HETRA scholarship.  HETRA Scholarships are based on your annual income with consideration made to your current family situation.  We also offer a discounted services program which is based on how many hours you volunteer for HETRA or how much you help raise in donations.  If you need to request a scholarship, outside funding sources or discounted services form please contact Erin Bevington at (402) 359-8830 or Erin@HETRA.org.   
Cancellations

If HETRA cancels a session (due to weather or staff illness, etc.):

The fees for each HETRA cancellation will be credited toward the next 12-week course invoice.

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

If a participant cancels a session: 

This session will not be available for a refund   

Participant tardiness:  Any time a Participant is late, their session time will be decreased accordingly in order for the schedule to remain intact.  If a Participant is 15 or more minutes late for a session they will NOT be allowed to ride for that session. 

Dropping out of a Course:  If your Participant drops out of a 12-week course without finishing all 12 weeks there will be a $50 fee assessed unless it was medically necessary.


If other is selected please fill in the fields below.
Individual Responsible for Payment









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











I have listed all significant medical information to the best of my knowledge: 



Liability Release

I/my child/ward 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 child/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 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 child/my ward may sustain while participating in Heartland Equine Therapeutic Riding Academy Programs.

 

WARNING - Under Nebraska Law, an 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 sections 25-21,249 to 25-21,253.           



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, speech, or mental health therapist prior to or during participation in HETRA programming. If physical therapy, occupational therapy, speech therapy, or mental health therapy as well as substance use therapy is deemed appropriate, I give consent for treatment and/or telehealth services as outlined by the therapist which could consist of individual or group programming.  I understand my session may consist of a cofacilitation session (therapist and instructor both involved in session) or cotreatment session (two therapists from different disciplines involved in same session).  I understand that volunteers will be part of the session as horse handlers, sidewalkers or assistants..    


Barn Rules
These guidelines have been developed for your safety.  Failure to follow these rules can result in 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, students 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 approved Horse Leader will be allowed to get horses from outside pens.
4. No untrained individual should enter a pen or stall with a loose horse in it. 
5. You should not be in any outside pen 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 - NEVER answer your phone while working 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 any 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 of the horses are on special diets and treats can be detrimental to their health. Please do not allow the 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 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 on or remove the 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 the cats is done at your own risk. Please monitor any children during their interaction with the cats.
19. All children under the age of 12 must be DIRECTLY monitored by an adult at all times while on the property.  Child must be in direct line of sight and adult must not be participating in any other activities such as volunteering or riding. 
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. 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 HETRA Instructors are 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 Instructors. Please be aware of all situations around you and report any unsafe situation 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.
24. HETRA is a Tobacco Free Facility.  Smoking or the use of any tobacco products is strictly prohibited on the HETRA property.  This includes the arena/barn area as well as the parking lot and adjacent buildings on the property.

HETRA does not discriminate on the basis of race, color, religion, national origin, gender, age, or disability in admission to it's programs, services, or activities, or any other aspect of their operations.

HETRA Volunteer & Guest Dismissal Policy: HETRA reserves the right to dismiss a guest or volunteer from the facility and from the program if their behavior is putting themselves, a participant, staff, other volunteers or the horse’s mental or physical health in jeopardy. The HETRA instructor in charge at the time of the incident will review the behavior with the volunteer and determine the level of intervention necessary. The level of intervention could include a verbal or written warning or immediate dismissal from the HETRA facility and program. Physical, emotional, mental or sexual abuse by a person at the HETRA facility will not be tolerated and will result in immediate dismissal from the HETRA facility. Alcohol consumption by a volunteer prior to a session is not allowed. A volunteer smelling of alcohol will not be allowed to assist with that night’s session.

Please follow these rules at all times while at the facility.  Anyone not following these rules will be asked to leave the facility.

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


Privacy Practices

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




Page 10

HETRA Code of Conduct

Heartland Equine Therapeutic Riding Academy - HETRA - is committed to creating a safe, positive, learning environment for all of our students, staff, parents, stakeholders, and community partners. HETRA will work to assure that all students and staff are well-motivated, fully aware of their potential and dedicated to the pursuit of excellence in equine, agricultural, and barn management knowledge, skills, and behavior.

 

Purpose of the Code

 

HETRA has adopted this Code to support the creation of a safe learning environment for all members of our community. The purpose of this Code is to state clearly our standards for acceptable conduct of participants. The Code also explains the consequences for not meeting these standards of conduct. This Code establishes a strict policy for conduct that endangers the safety of our programs and/or disrupts the educational experience for other students.


The Code also sets forth the discipline procedures for the students who have committed violations of the Code. This Code is not meant to be a contract between HETRA and its participants, and may be amended at any time. It is a place for HETRA to explain certain policies applicable to participants.

 

Equal Opportunity Statement

 

HETRA complies with all federal, state and local laws, and provides an equal opportunity for all participants. HETRA prohibits discrimination in program acceptance, progress of participants, discipline and any other activity based on race, creed, color, national origin, religion, ancestry, age, marital status, sexual orientation (known or perceived), gender identity expression (known or perceived), gender, disability, nationality or citizenship.

 

All decisions of HETRA will be administered without regard to any of the categories listed above.

 

Statement of Participant Misconduct

 

The rules in this Code are designed to notify participants as to the types of behaviors that are unacceptable; nevertheless, every specific variation of the prohibited conduct may not have been included. Consequently, participants should expect to be disciplined for misconduct that is obviously inappropriate. A specific rule need not be written for every conceivable variation of behavior that directly affects the orderly mission of HETRA and its programs.

 

DEFINITION OF DISRUPTION AND INTERFERENCE WITH ANY HETRA PROGRAM

 

No participant shall cause or attempt to cause (either directly or indirectly) a disruption or interference with a program by any means including, but not limited to, any of the following behaviors:

  • Pull fire alarm or tamper with any safety device. 

  • Show disregard, intentionally or unintentionally, for any barn or equine related safety rule whatsoever;

  • Occupy or block any area of the property, prevent or attempt to prevent participants from attending a session, activity or event;

  • Be on property without a designated staff member present, walk away from or separate themselves from assigned group;

  • Program disruption. A participant may not in any manner, by use of violence, noise, force coercion, threat, intimidation, fear, passive resistance, insult, or other conduct, intentionally or unintentionally cause the disruption of any lawful mission, process, or function of HETRA

  • Group, or class disruption. Participant behavior that is repetitive or substantially interferes with the instructor’s ability to teach and/or participants' ability to learn;

  • Disorderly conduct. Any act that substantially disrupts the orderly learning environment, or poses a threat to the health, safety and/or welfare of participants, staff and others;

  • Refuse to wear identification badge, identify himself/herself upon request of any staff member;

  • Urge, encourage, or counsel other participants to violate any rules of the HETRA Conduct Behavior Code;

  • Willfully leaves group, classroom, session, or the premises without consent of a staff member;

  • Oral threat/verbal assault, rude or disrespectful gestures, use of profanity, any form of expressed harassment which has the intentional or unintentional effect of undermining the authority of HETRA

  • Posturing to inflict personal harm.

  • Drug or alcohol use. 

 Reporting of Repeated and Substantial Program Interference

 

HETRA Staff will report any participant's violation of the HETRA Conduct Behavior Code which repeatedly or substantially interferes with the instructor’s ability to communicate effectively with the participants in his or her class or with the ability of the participants in his or her class to learn. Staff will report any such incidents to the Executive Director or Executive Director’s designee immediately. A designated HETRA staff member will share report with participant’s parents or guardians within a reasonable time frame. 



Contact Information