Heartland Therapeutic Riding - 2019 Horsemanship Camp Application

General Info
If you need a different week than your age group is assigned, please contact us at info@htrmail.org and we will see what we can do.
Emergency Information
Diagnosis and Medical History
If your child has do diagnosis, select "Typically developing - No Diagnosis"
Seizure Information (skip this section if the participant does not have a history of seizures)
Participant Profile
Communication Skills
Liability Release
(You will also be required to sign a hard copy of this form in order to participate in any capacity at Heartland Therapeutic Riding, Inc.)
  1. 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. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages or otherwise against Heartland Therapeutic Riding, Inc., its Board of Directors, Officers, Instructors, Therapists, Aides, Volunteers and/or Employees for any and all injuries and/or losses I/my son/my daughter/my ward may sustain while participating at Heartland Therapeutic Riding, Inc. WARNING: Under Kansas Law (K.S.A. 60-4001 through 60 – 4004), 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. Inherent risks of domestic animal activities include, but shall not be limited to:
      1. 1. The propensity of domestic animals to behave in ways (i.e., running, bucking, biting, kicking, shying, stumbling, rearing, falling or stepping on) that may result in an injury, harm or death to persons on or around them
    1. 2. the unpredictability of a domestic animal’s reaction to such things as sounds, sudden movement and unfamiliar objects, persons or other animals;
      1. 3. certain hazards such as surface and subsurface conditions;
        1. 4. collisions with other domestic animals or objects; and
          1. 5. the potential of a participant to act in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the domestic animal or not acting within such participant’s ability.

Yes, I would like above named person to participate in an equestrian program at Heartland Therapeutic Riding, Inc. I understand and agree that Heartland Therapeutic Riding, Inc., its Board of Directors, Officers, Instructors, Therapists, Aides, Volunteers and/or Employees will have NO LIABILITY in the event of any accident that may occur. No person can be accepted to participate in a Heartland Therapeutic Riding, Inc. program until this form has been completed by the parent(s)/ guardian. If the person is of legal age (18), he or she may complete the form if he or she is legally competent to do so. All activities will be under supervision and, although reasonable effort will be made to avoid any accident, Heartland Therapeutic Riding, Inc. will have NO LIABILIITY. I acknowledge that any involvement with horses is a high-risk activity. I have read this notice and release of liability and fully understand and agree with its content.                                                                                       
Photo Release