Annual Update Form

Program - Participant Registration & Annual Update Form

  • Height and weight are used in horse and volunteer assignments.
  • 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.
  • MM slash DD slash YYYY
    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).
  • MM slash DD slash YYYY
    At High Hopes we place great importance on protecting the confidential information of our clients, our volunteers, and our staff. "Confidential Information" includes, but is not limited to, personally identifiable information such as surnames, clients, and information about their disabilities or special needs must be protected as confidential information. I shall never disclose confidential information to anyone other than High Hopes staff. I must seek staff permission before taking any pictures or videos. I have read and understand the High Hopes Confidentiality Policy and agree to abide by the same.
  • MM slash DD slash YYYY
  • (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.
  • MM slash DD slash YYYY

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