HETRA Life Skills 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 $15 per daily session and billed at the beginning of the 12 week course. 
  • Registration Fee:  A annual $30 registration fee is charged at the time the participant returns for sessions.
  • Reevaluation Fee:  a reevaluation fee of $55 is charged any time a participant needs to be reassessed by a therapist due to a change in their situation.

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.  We would prefer that your participant wore pants instead of shorts as the saddle can get very uncomfortable with direct skin contact.

 

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














Mother/Guardian Information (minor or dependent adult only)












Father Information (minor or dependent adult only)













If other is selected please fill in the fields below.
Individual Responsible for Payment (only if other than Mother or Father)









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



Photo Release



Medical Consent


Consent to Treat 



Barn Rules


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

COVID-19 ACKNOWLEDGEMENT OF RISK AND ACCEPTANCE OF SERVICES
AS OF MAY 11, 2020 - REQUIRED FOR ALL STAFF, CONTRACTORS, VOLUNTEERS, PARTICIPANTS, PARTICIPANT CAREGIVERS AND FAMILY AS WELL AS ANY GUESTS TO THE HETRA FACILITY.

I am aware of the risks of contracting or spreading Covid-19 while working or volunteering at Heartland Equine Therapeutic Riding Academy; attending an event; and/or receiving on site services from Heartland Equine Therapeutic Riding Academy during the time of a pandemic outbreak. 

I am aware that on site services and experiences may increase my risk of contracting and passing on the Covid-19 or Coronavirus and agree to hold harmless Heartland Equine Therapeutic Riding Academy and its Board of Directors, staff, Medical Advisor Board, members, officers, managers, agents, employees, volunteers and all other individuals I may come in contact with during this interaction and receiving of services, providing services, attending an event, volunteering within this organization or visiting. 

I agree to and will follow all guidelines for personal hygiene, personal safety and public safety as recommended by Heartland Equine Therapeutic Riding Academy; as well as my individual provider/practitioner. This may include, but is not limited to, maintaining social distance; limiting the number of people attending with me to what is outlined by the organization at the time, washing my hands prior to and following each session or activity; use of hand sanitizer upon request; wiping down surfaces with disinfecting wipes and/or wearing a mask and/or gloves. 

I agree to stay home and/or cancel my time at Heartland Equine Therapeutic Riding Academy should I have personally exhibited or have been in contact with someone who has presented with illness within the previous 24 hours to 2 weeks, including; cough, sneezing, fever, chest congestion or additional signs of potential spread of any virus or bacteria/disease. In addition, I will follow the recommendations of my provider once I have notified them of these risks in regards to my future services or attendance during this pandemic.

Heartland Equine Therapeutic Riding Academy will engage in regular cleaning and sanitizing of the facility, horse tack, equipment, doors, and frequently touched areas in-between participants and on a daily basis as recommended by the CDC for the safety of participants, their families, employees, volunteers and horses. 

I am signing under my own free will and agree to follow these and hold harmless all individuals associated with Heartland Equine Therapeutic Riding Academy

BY SIGNING BELOW, I CONFIRM THAT I HAVE READ AND UNDERSTAND THIS DOCUMENT.

*In the event that the undersigned is under the age of 19, the signature of a parent or guardian is required.


HETRA Participant Photography and Social Media Policy

Videos and Photography taken at the HETRA Facility Policy:  

 

In order to protect you or your participants privacy as well as the privacy of others at the HETRA facility and due to the sensitive, private, and personal nature of our participants and the services we offer, we must exercise every precaution when taking photos or videos at HETRA.  At this time we ask that all participants and families follow this process if they would like a picture of their participant while at the HETRA facility.  Please do not take any picture or video at any time while at the facility on your own, please use the following procedure for any picture or video requests. 

 

Procedure for pictures or videos of their participants while at HETRA:


1.   Please notify your instructor or therapist that you would like a particular picture or video taken of your participant.

2.   HETRA instructor or therapist will supervise taking of the picture on a HETRA approved devise. 

3.   Once the picture/video has been taken it will be sent to the designated staff for approval (this allows the staff to check photo releases on everyone and make sure other participants/volunteers are not in the photo and there is no confidentiality issues related to the photo).  Designated staff includes - CEO, COO, Equine Operations Manger and Program Manager. 

4.   Once approved the photo will be sent to the requesting party.  We will do our best to make this a very timely process.  

 

Social Media:


Heartland Equine Therapeutic Riding Academy (HETRA) embraces social media and relies on our participants, staff, and volunteers to increase our online presence and build our brand. It is one of the most powerful platforms we have to share our mission, create positive awareness for our organization, and engage with our community on a daily basis. We highly encourage participants to engage with HETRA’s social platforms by liking, commenting, and sharing our posts.  

 

Where to find HETRA:


Facebook            TeamHETRA                                                     

Twitter                @HETRA            

Snapchat            Team HETRA

Instagram           team_HETRA

You Tube            HETRANebraska             

Linked In            HETRA

 

ALWAYS:

·     Help HETRA spread the good word - share, retweet, and regram HETRA posts on your own social platforms. 

·     Refer to HETRA horses in a positive manner and forward inquiries about HETRA horses to a staff member

·     Think twice before posting. If you have any doubt, please do not post.

 

NEVER:

·     Claim to be an official representative of HETRA

·     Share confidential information about a participant, volunteer, employee or the organization

·     Take photographs or video of a HETRA participant, volunteer, HETRA facility, horse or employee unless specifically approved to do so by a designated staff member


·     Use language that is profane, harassing, racial, political, religious, or that is considered biased or slurred when posting about HETRA.

·     Refer to a HETRA horse or the HETRA barn environment negatively.

 

Violation of Social Media Policy

 

If a social media post is discovered that is in violation of this policy, you will be asked by a staff member to remove the post. Failure to remove a post could result in verbal or written warning or immediate dismissal from the HETRA facility and program.



Page 11

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.