Reining Strength Client Application

Client Name

Birthdate

Nickname

Gender

Height

Weight

Ethnicity

County

Parent/Guardian/Participant #1 Information

First Name

Last Name

Employer

Home Phone

Cell Phone

Work Phone

Preferred Phone

Mailing Address

City

State

Zip

Parent/Guardian #2 Information (if applicable)

First Name

Last Name

Employer

Home Phone

Cell Phone

Work Phone

Preferred Phone

Mailing Address

City

State

Zip

Designated Caregiver Information (if applicable)

Designated Caregiver First Name

Last Name

Home Phone

Cell Phone

Work Phone

Client School/Employer Information

School/Employer Name

Grade Completed

Secondary School Program (if applicable)

Referral Information

How did you hear about Us?

Referring Group/Company/Organization

Contact Name

Phone

Military Service

Served in Military

Rank

Branch

Dependent of Military Service Member

Name of Service Member

Relationship to client

Client Policies

Punctuality

It is extremely important for a client to arrive approximately 5 minutes prior to their scheduled session.

Late Arrival Policy

If a client is late to their scheduled session time, Reining Strength cannot guarantee he/she will be able to ride. Horses may be untacked and volunteers released 15 minutes after the scheduled start time of the class. Reining Strength appreciates good communication.

Attendance & Cancellation Policy

If Reining Strength agrees to provide services to our clients and our clients agree to an appointed time, then both parties are responsible for doing their part in making sessions successful. Reining Strength will have the proper staff, volunteers, and horse waiting for the client’s arrival.

In order to maximize the client’s progress, it is critical that he/she attend all scheduled sessions. Arriving late or missing sessions impairs the client’s ability to progress, disrupts staff schedules, limits other clients’ abilities to obtain appointments and may affect agency coverage. It is important that we maximize appointments!

Please note the following:

1. If a client must cancel an appointment, please call the office at 832-451-6874 48 hours or more in advance. Lesson cancellations are only accepted via phone call.

2. Participants are allowed one approved absence per session (Spring I, Spring II, Summer, Fall). The tuition for the approved absence will be credited to next session's bill.

3. All cancellations made less than 48 hours prior to an appointment will result in the tuition for that lesson to be forfeited. Agencies will not pay these charges, so families need to be prepared to pay out of pocket.

4. If clients do not call or attend their appointment time, the absence will be marked as a "no-show". Multiple no-shows may result in loss of an appointment time.

5. Three cancellations in a row OR five cancellations per fiscal year could result in the loss of the client's scheduled appointment time and/or scholarship. Fees may be waived with a Doctor’s written excuse.

6. Reining Strength will work when possible to have weather related make-up days.

7. If individuals are returning after an injury or hospital stay, a note from the doctor to return to RSTH services is required.

Weather Policy

1. If temperature + humidity is over 100 or if temperature drops below 32 degrees Fahrenheit, ground lessons may be administered when possible or classes will be cancelled.

2. Reining Strength will cancel classes in the event of a Lamar ISD school cancellation due to weather or if there is a National Weather Service warning for our area.

3. In the event of a session cancellation due to inclement weather, Reining Strength will notify the Client/Participant or the Client's Representative. Please make sure that Reining Strength has a current phone number and email for notification purpose.

Client Name

Date

By entering my name below I agree that I have read and understand what is written and agree to follow the policies and procedures set forth by Reining Strength Therapeutic Horsemanship.

Client Rules and Regulations

Safety Requirements

Individuals may not be allowed to participate in the program if any of the following situations occur:

1. The client’s physical condition is in any way exacerbated by riding or receiving services at Reining Strength.

2. An appropriate horse is no longer available for the Client.

3. The Client’s behavior poses safety concerns for the Client, Staff, Volunteer or Horse (at the discretion of the instructor).

Rules and Regulations

1. Clients/Guardians/Parents are required to sign a variety of forms; including but not limited to a photo release, liability release, emergency medical form, and attending physician forms. All forms must be completed and signed prior to any participation in Reining Strength activities.

2. If the Client is under 18 years of age or has a legal guardian, a designated adult must be on the premises at all times while the client is on Reining Strength property unless prior approval has been obtained.

3. WARNING UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), A FARM ANIMAL PROFESSIONAL OR FARM OWNER OR LESSEE IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN FARM ANIMAL ACTIVITIES, INCLUDING AN EMPLOYEE OR INDEPENDENT CONTRACTOR, RESULTING FROM THE INHERENT RISKS OF FARM ANIMAL ACTIVITIES.

4. For the safety of everyone, off-limit areas are posted. The designated viewing area is on the South side of the arena. Reining Strength requests that all children be supervised while on Reining Strength premises.

5. Personal pets are not allowed on property, with the exception of service dogs.

6. All clients, staff and volunteers are required to wear an ASTM-SEI approved equestrian riding helmet during all mounted equine activities unless an Alternative Helmet Waiver has been filed in the client’s file.

7. Photo releases are required paperwork and permission must be obtained before photos are taken of clients, parents, instructors, volunteers and staff.

8. Clients should dress appropriately for horse related activities. This includes, but is not limited to, comfortable, closed-toe safe shoes, weather appropriate attire, sunscreen if applicable, etc.

9. Out of respect to others, clients, staff and volunteers, will not wear revealing clothing or any clothing advertising alcohol,, drugs, firearms, gang colors, sexual content, or other inappropriate subject matter.

10. NO SMOKING OR VAPING ON THE PREMISES.

11. For the safety and respect of others, clients, staff and volunteers will not bring alcohol or drugs onto Reining Strength premises. Nor will clients, staff or volunteers be under the influence of alcohol or drugs while on Reining Strength premises.

12. For the safety and respect of others, NO weapons of any kind are permitted on the premises.

13. Reining Strength is private property. For admittance outside of operating hours, prior authorization is needed by the Executive Director.

14. Violation of any of these rules may result in immediate termination from the program.

Client Name

Date

By entering my name below I agree that I have read and understand what is written and agree to follow the policies and procedures set forth by Reining Strength Therapeutic Horsemanship. I understand and I am aware of the Texas Farm Animal Liability Act (written #3 above).

Photo Release

For valuable consideration given and which is hereby acknowledged, the undersigned hereby grants to Reining Strength Therapeutic Horsemanship permission to take, or have taken, still and moving photographs and films of the above named individual, including television pictures, and consents and authorizes Reining Strength Therapeutic Horsemanship, its advertising agencies, news media, and any other persons interested in Reining Strength Therapeutic Horsemanship and its work, to use and reproduce the photographs, films or pictures, and to circulate and publicize the same by all means, including, without limiting the generality of the foregoing, newspapers, television media, brochures, pamphlets, instructional materials, books, and clinical materials. Please note that your presence or participation in a public event at Reining Strength Therapeutic Horsemanship or event involving Reining Strength Therapeutic Horsemanship constitutes a tacit waiver of this non-consent. Electing the non-consent option will not necessarily prevent a subject from being photographed or filmed at any such event by Reining Strength Therapeutic Horsemanship or the general public. With respect to the foregoing matters, no inducements or promises have been made to secure this signature to this release other than the intention of Reining Strength Therapeutic Horsemanship to use, or cause to be used, such photographs, films, and pictures for the primary purpose of promoting Reining Strength Therapeutic Horsemanship and its work.

By entering my name below I agree the photo release statement above.

Client Name

Date

Liability Release

the undersigned adult as client, or parent or guardian of

, a minor, would like to participate at Reining Strength Therapeutic Horsemanship.

I acknowledge the risks and potential for risks of equine activities. I understand that I/my son/daughter/ward, will be working with and around horses, as well as, riding horses at Reining Strength Therapeutic Horsemanship. However, I feel that the possible benefits to myself/son/daughter/ward are greater than the risk assumed. I, the undersigned client and/or parent or guardian, hereby, intending to be legally bound, for myself, my heirs, and assigns, executors or administrator, waive and forever release, acquit, discharge and hold harmless all claims for damages against Reining Strength, its board of directors, trustees agents, instructors, therapists, employees, representatives, volunteers, owners of property on which Reining Strength Therapeutic Horsemanship operates, successors or assigns on account of any personal injuries and/or personal damages known or unknown, or in any way growing out of, the acts of Reigning Strength Therapeutic Horsemanship, its board of directors, trustees, agents, instructors, therapists, employees, representatives, volunteers, owners of the property on which Reining Strength Therapeutic Horsemanship operates, successors or assigns.

By entering my name below I understand that under TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), A FARM ANIMAL PROFESSIONAL OR FARM OWNER OR LESSEE IS NOT LIABLE FOR
AN INJURY TO OR THE DEATH OF A PARTICIPANT IN FARM ANIMAL ACTIVITIES, INCLUDING AN EMPLOYEE OR INDEPENDENT CONTRACTOR, RESULTING FROM THE INHERENT RISKS OF FARM ANIMAL ACTIVITIES.

Date

Authorization for Emergency Medical Treatment

Client Complete Legal Name

Date of Birth

Physician Name

Medical Office/Facility

Health Insurance Company

Insurance Status

Allergies (medications/food/other)

Current Medications

Emergency Contact Information

#1 Name

Home Phone

Cell Phone

Work Phone

#2 Name

Home Phone

Cell Phone

Work Phone

#3 Name

Home Phone

Cell Phone

Work Phone

Medical Treatment Consent

In the event that emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on Reining Strength Therapeutic Horsemanship property, I authorize Reining Strength Therapeutic Horsemanship, to:

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

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

This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed “life-saving” by the physicians. This provision will only be invoked if none of the Emergency Contacts listed above can be reached.

By entering my name below I agree the medical treatment statement above.

Date