Equest Participant Application

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This information must be updated and submitted annually.

CONTACT INFORMATION

Client First Name

Client Last Name

Street

City

State

Zip Code

County

Home Phone

Mobile Phone

Work Phone

Personal Email

Client School or Employer

Grade or Occupation

PARENT/GUARDIAN/CAREGIVER INFORMATION

(will also serve as emergency contact)

First Name

Last Name

Relation to Client

Phone

First Name

Last Name

Relation to Client

Phone

EMERGENCY CONTACT INFORMATION

(if other than parent, guardian, or caregiver listed above)

First Name

Last Name

Relation to Client

Phone

First Name

Last Name

Relation to Client

Phone

SCHOLARSHIP INTEREST

Are you interested in scholarship opportunities?

YesNo

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PHOTO RELEASE

For valuable consideration given and which is hereby acknowledged, the undersigned hereby grants to Equest permission to take, or have taken, still and moving photographs and films of the above named Rider, including television pictures, and consents and authorizes Equest, its advertising agencies, news media, and any other persons interested in Equest 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 Equest or event involving Equest 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 Equest 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 Equest to use, or cause to be used, such photographs, films, and pictures for the primary purpose of promoting Equest and its work.

Photo release consent

I give consent.I do not give consent.

RELEASE OF LIABILITY

This form is required to participate in all activities and must be updated annually.

Equest, its officers, members, employees, and agents (including volunteers) will not be responsible for any damages to person, animal or property at the Equest Therapeutic Horsemanship Center or its grounds, nor will they be responsible for any property lost or destroyed. The undersigned Client or parent/guardian hereby releases Equest, its officers, members, employees, and agents from any and all liability and claims of any nature whatsoever, including taking any action to control, restrain, or confine the undersigned, for the safety or protection of the undersigned or others and any damages whatsoever (including costs, expenses, and attorney's fees) that might result from damages, injuries, or losses to their person or property during, or in connection with, or arising out of, any class, lesson, demonstration, show, clinic, event or other function, WHETHER OR NOT SUCH DAMAGES, INJURIES, OR LOSSES RESULT DIRECTLY OR INDIRECTLY FROM THE NEGLIGENT ACT OR OMISSION OR OF ANY INTENTIONAL OR WILLFUL ACT OR TORT OF SUCH RELEASED PARTIES OR OF ANY INVITEE OF ANY RELEASED PARTY.

WARNING: UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), 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.

In exchange for the use of property owned by Equest and other valuable consideration, I agree that my use of the premises and any animals, facilities, or equipment owned by Equest is at my own risk. I further agree to indemnify and hold harmless Equest, and its respective officers, members, employees, and agents, from any and all suits, actions, or claims of any type arising from my use of the premises or participation in an equine activity, or of such use or participation by my guest, whether or not such claims result directly or indirectly from the negligent act or omissions of the indemnified parties or otherwise.

I acknowledge involvement with horses, is a high-risk activity. I have read this agreement and fully understand its content.

I consent.I do not consent.

SAFETY POLICY

For the safety of our riders, horses, and volunteers, we adhere to our veterinarian’s recommendations for height to weight ratios listed here. If you are outside the height to weight ratios, accommodations can be made at the discretion of the Program Director.

Under 5’0” tall = 150 lbs

5’0”-5’6” = 175 lbs

5’7”-6’0” = 200 lbs

6’1”- 6’5” = 250 lbs

Client is within the Equest standard height to weight ratio for mounted activities.Client is not within the Equest standard height to weight ratio for mounted activities.

NO-SHOW & CANCELLATION POLICY

We ask that the following policies be adhered to so that we may be able to offer the best quality program possible.

Please arrive a few minutes early for your class. This will give you a chance to use the rest room, get your helmet on, and be ready to mount on time. It may not be possible to mount a late arrival and if the arena gate is closed and the class has already started, then you will not be able to ride that day.
We will consider you “absent” if you have notified us at least 24 hours in advance. Otherwise, we will consider you a “no show.”
If you will be absent, please call (972) 449-1299. PLEASE LEAVE A VOICE MAIL clearly stating your name, class day and class time.
In the case of an emergency, the rider or parent/guardian should call within 24-48 hours after the emergency.
In the case of a sudden illness, the rider or parent/guardian should call as soon as it is apparent they will not be able to attend due to illness.
Excessive absences (3 or more) or no shows (more than 1), will be subject to losing your class slot and being placed at the end of the waiting list.
Riders who have been awarded a scholarship for the semester and have more than 1 “no-show” will be subject to forfeiting the scholarship and being ineligible for future scholarships.
There will be NO refunds or make-up for missed classes unless Equest must cancel for weather or scheduling. Payment for the semester is required before the semester begins.
If you must withdraw from the semester after it has begun, please contact Angela Escamilla at aescamilla@equest.org or (972) 412-1099 ext. 209.

“No-Show, no-calls” result in:

Decrease in recruiting and retaining volunteers

Unnecessary tacking and untacking of our horses

Inefficient use of staff and volunteers

Additional Information for Hippotherapy Clients

We require a minimum of 24 hours’ notice for the cancellation of a therapy appointment. Cancellations made less than 24 hours in advance may be considered a “no-show” and subject to a cancellation fee of $90.

Cancellations made for reasons that could be rescheduled for another time, such as other therapies, doctor appointments, and vacations must be turned into your therapist a minimum of 2 weeks prior to the absence.

Cancellation policy

I have received and understand the Equest No Show and Cancellation Policies.I have not received nor do I understand the Equest No Show and Cancellation Policies.

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HOW CAN I HELP EQUEST?

We ask for your voluntary response to the following questions as we grow and expand our services. This information will be used ONLY for purposes of fundraising, obtaining financial and in-kind support from foundations and other support agencies as well as government entities. Your responses will in no way influence your registration or participation at Equest.

Are you interested in helping volunteer at Equest?

YesNo

Equest Affiliation

ClientClient Parent or CaregiverVolunteerFriend

CIVIC OR SERVICE ORGANIZATIONS

Please acknowledge your affiliation with other organizations, and include the name.

Select all that apply

To select multiple, hold CTRL and click all that apply.

Club Name

League Name

Organization Name

EMPLOYMENT

Your Employer

Spouse Employer

Parent Employer 1

Parent Employer 2

Jingle Mingle	Gala	Fall Fun Fest
Spring Horse Show