Equine Therapeutic Program

PAINTS-PLUS EQUINE CENTER EQUINE THERAPEUTIC PROGRAM APPLICATION

Please click all Sessions you plan to take.

Session #1: Oct 13-Dec 1, 2023

Session #2: March 1-April 26, 2024 (skip Good Friday March 29)

Please click all Times that works for you:

Fridays 430-5pm (Shiloh private group)

Fridays 5-530pm

Please click on which program(s) you are interested in:

Therapeutic Horseback Riding

Hippotherapy

Would you like to rent a Small Storage Locker upstairs (fits helmet, boots, etc) $10/session BYO lock?

First & Last Name of person paying invoices

Student First & Last Name

Email for invoices and event notifications

Cell Phone Number (no spaces or -)

Emergency Phone Number (no spaces or -)

Mailing Address

City

Postal Code

Where did you hear about us?

List Previous Riding Experience

MEDICAL INFORMATION

Rider Age

Height (feet/inches) - to assign suitable horse

Weight (lbs) - to assign suitable horse

Type of Disability:

Any other Medical Conditions/Allergies we should be aware of?

List any on-going medications

Ambulatory Status

Do you require a personal aide?

Is there anything else we should know?

Total Fees for 8 Weekly lessons is $500+GST without sponsorship. The Colchester & District Agricultural Society will be sponsoring up to 12 students each session for $200 each to cover part of the cost. Full payment must be received at Paints-Plus before they will send out a cheque for the sponsorship to the payee within the first week of the session.

Lesson Payments must be received 1 month prior to the start of each session, or half 1 month prior with balance paid by Session start date. Invoices will go out ahead. Late payments will be charged $20 after session start date and no lessons can be taken until paid. Your spot may be filled with next student on waiting list. Please check which payment method you plan to use:

Paypal to lisa.dave.harrison@gmail.com (with 3% service fee added)
E-transfer to lisa.dave.harrison@gmail.com (use the day of the week of your lesson as security question)
Cheque by mail or dropped in barn mailbox (payable to Lisa Harrison)

Classes with 3 or less riders may be cancelled or combined.

WAIVER -- Acknowledgement of RISK and RELEASE of LIABILITY –“For All Participants ”--Please Read Fully

The Parent/Guardian/Participant must Read and Understand prior to Participating in Equine Activities. By Selecting Yes to each of these questions and submitting the form the Parent/Guardian/Participant has read it and states that they understand it. The Parent/Guardian/Participant further state they am aware that by submitting this form they waive certain legal rights they and the Parent/Guardian/Participant and/or there “Legal Representatives” might have against Paints Plus Equine Center and its employees.

I am the adult Participant named below or I am the Parent and/or Legal Guardian of the infant Participant named below and am executing this form on behalf of the infant Participant in my capacity as parent and/or guardian and with the intent that this form be binding on myself and infant Participant for all legal purposes.

Yes

I Understand there are Inherent DANGERS, HAZARDS and RISKS, (collectively called RISKS) associated with Equine Activities and injuries resulting from these “RISKS” are a common occurrence.

Yes

I Acknowledge that the Inherent “RISKS” of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to:

Yes

The propensity of any equine to behave in ways that might result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people, or objects. The unpredictability of an equine’s reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects. The potential for other participant(s) to act in a negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability or to maintain control over an equine.

Yes

The Participant and/or the Participant’s Guardian understands and acknowledges, the risks, dangers, and hazards which are inherent on entering all lands, properties, facilities, structures, installations, vehicles or equipment owned, leased, operated or otherwise controlled by the Organization (the “Premises”), which risks include, but are not limited to: the potential for bodily injury or illness (including contraction of COVID-19); contact or interaction with others who may have been exposed to COVID-19; close proximity to or contact with surfaces, equipment, fixtures, or other objects that, despite the Organization’s efforts, may be infected with COVID-19 or other communicable illnesses; permanent disability, paralysis, or loss of life; collision with natural or manmade objects; tripping hazards; imperfect venue or field of play conditions; equipment failure; participants of varying skill levels; the negligent use of the Premises by others; inadequate safety measures or unsafe Premises; other circumstances known, unknown or beyond the control of the Organizer, its partners, sponsors, agents, affiliates, directors, employees, officers, therapists, or volunteers (together, the “Releasees”); or negligence or omission of the Releasees (collectively, the “Risks”).

Yes

Freely Accept and Fully Assume All Responsibility for the Inherent “RISKS” and the possibility of personal injury, death, property damage or loss which might result from Participating in this Activity

Yes

I Acknowledge that it remains my Sole Responsibility for the safety of the infant Participant and myself and for the infant or myself to Participate within his/her/my own limits.

Yes

In addition to consideration given for the Parent/Guardian/Participant to Participate in Equine Activity, I and my heirs, executors, administrators and assigns (collectively called my “Legal Representatives”) agree.

Yes

To Waive All Claims that the Parent/Guardian/Participant might have against the “HOST”; and To Release the “HOST” from Any and All Liability for any loss, damages, injury, or expense that the Parent/Guardian/Participant Participant or our “Legal Representatives” might suffer as a result of the Parent/Guardian/Participant's Participation due to any cause including any NEGLIGENCE ON THE PART OF THE “HOST”; and • To HOLD HARMLESS AND INDEMNIFY THE “HOST” from any and all liability for property damage or personal injury to the Parent/Guardian/Participant or to any third party which might result from the Parent/Guardian/Participant's Participation.

Yes

PAINTS-PLUS EQUINE CENTER LESSON STUDENT RULES

YARD RULES • When in yard, barn or arenas, all horses must be supervised and have a halter, rope on bridle on for control. • Please do not hand feed any horses or give treats to other people’s horses without permission. Chop apples. • Smoking and swearing is prohibited on the on the property. No dogs allowed as we already have 3. Please respect the privacy of the yard areas in front and behind the house. Do not enter the back yard. In the yard, dispose of your horse’s manure in a pen or manure spreader or use the muck tubs provided.

BARN RULES • Barn and Arena doors are to be kept closed. Windows may be opened in summer months to cool barn. • Please only tie horses in grooming stalls in barn or to rings outside of indoor arena by outdoor arena. • Sweep up dirt/hair and your horse’s manure BEFORE and AFTER riding, using shovels and tubs provided. • Put grooming equipment away during your ride. PPEC is not responsible for lost or stolen articles. • Anyone caught by security cameras as having not cleaned up will get a $10/incident clean-up charge added. • Last person out of the barn & arena, please turn off all inside lights. Outside lights are on timers.

ARENA RULES • Everyone riding or working at PPEC must read, understand & sign/submit a Release of Liability Waiver. • General riding is allowed in the arenas during lessons, however the lesson instructor has control of the arena • Heeled footwear and long pants are mandatory while riding. No sandals or bare feet when near any horse. • ASTM Approved Riding Helmets are mandatory for riders under 18, and for all riders while in lessons. • Please adhere to the following arena etiquette: When you are entering the indoor arena, look through window to see when it’s safe and announce yourself by saying “Door!” before you open it. Check your girth and tack before mounting. If a jumping lesson is in progress, familiarize yourself with the course being ridden so as not to get caught in an unsafe location. Horses in lesson have the right of way. If a rider and/or horse should fall or in case of a power outage, STOP all movement immediately and listen to instructors instructions.

LESSON HORSE RULES • Do not go into any field or attempt to catch your horse without instructor supervision. • Tie horses short in grooming stalls in barn or to rings attached to outside of indoor arena by outdoor arena. • Winter Blankets - undo back first and do up front first on winter blankets correctly to avoid injuries to people or horses and destruction of blankets. Make sure clips are closed properly as sometimes they stick. • Always groom, tack-up and cool-out your horse as per lesson instructors or TA’s directions. • Use only tack/supplies designated for your lesson horse. If you cannot locate something, please ask. • Please pick-up manure & sweep barn before and after riding. Grooming buckets should be put away during lesson. Keep your stuff upstairs or in your locker. PPEC is not responsible for lost or stolen articles. • Do not hand feed the horses unless instructed to use a treat to catch. Put approved treats in their buckets. • If you observe something that you don’t think is right, alert the instructor or TA, don’t attempt to correct alone. • Please do not “beautify” the lesson horses (no cutting manes/tails, no braids left in when turned out.)

Sorry we don't offer make-up lessons in for this program.

I acknowledge that I have read and understand the Paints-Plus Equine Center Rules, and agree to abide by them.

Yes

I have read this form (as indicated by my responses above) and I state that I understand it. I further state I am aware that submitting this form, waives certain legal rights the Parent/Guardian/Participant Participant and/or our “Legal Representatives” might have against Paints Plus Equine Center and its employees.

Name of Participant

Birthdate of Participant (MM/DD/YYYY)

Name of Parent/Legal Guardian (If Participant is under 18)

Do not submit until you have read and understand all items above.

After you hit submit, it should change to a screen that says it was successfully sent. If not, please try again.