COVID Release Form

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.