Authorization for Emergency Medical Treatment
(to be invoked in the event that your Emergency Contact cannot be reached.)
If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.
High Hopes Therapeutic Riding, Inc. 1) to use my child’s photograph or image in its print, online and video publications; 2) release High Hopes Therapeutic Riding, Inc., its employees and any outside third parties from all liabilities or claims that I might assert in connection with the above-described activities and 3) waive any right to inspect, approve or receive compensation for any materials or communications, including photographs, videotapes, DVDs, website images or written materials, incorporating photos/images of me(my child).
(Name) would like to participate in the High Hopes
Therapeutic Riding Inc. program. I acknowledge the risks and potential for risks of horseback riding and related equine activities,
including grievous bodily harm. However, I feel that the possible benefits to myself/my child/my ward are greater than the
risk assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors, and administrators, waive
and release forever all claims for damages against High Hopes Therapeutic Riding, Inc., its Board of Directors, Instructors,
Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I/my child/my ward may sustain while
participating in the Program from whatever cause including but not limited to the negligence of these released parties.
The undersigned acknowledges that he/she has read this Registration and Release Form in its entirety; that he/she
understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.
Thank you for completing our Prospective Rider Application. You will now be redirected back to the forms page.
To complete the application process please download the physician’s form and have your physician complete and return to High Hopes, in addition if the applicant sees a Physical Therapist, Occupational Therapist, Mental Health Professional, Speech Language Pathologist, please download or direct your therapist to the forms page. Upon completion the applicant will be placed on the High Hopes wait list. A letter confirming the complete application and waitlist status will be sent to the address provided. Applicant will be contacted to schedule an assessment at a fee of $50 when an appropriate lesson/activity have been identified.
Please do not hesitate to call with questions (860) 434-1974.
Scholarship applications will be requested and reviewed when an appropriate activity and available spot in program have been determined.