HORSEBACK RIDING LESSONS
For pearl river classified students
Life’s Journey Equine Therapy located at Silver Rock Farm is pleased to be offering two types of recreational and therapeutic group riding lessons.
Basic Group instruction includes grooming, horse handling, identifying equipment, mounting and dismounting, correct postures and positions of riding. This group is suitable for beginners and for individuals of all abilities. A maximum of 10 riders will be allowed per group at a cost of $50 per participant for a ten week session.
Comprehensive Group instruction provides a more in depth exposure to all of the above with a greater emphasis on developing independent riding skills. This group is for individuals with a classification of LD and with previous riding experience. A maximum of 6 riders will be allowed per group at a cost of $250 per participant for a ten week session.
Available Times: Saturday 12:30 – basic group begins March 29
Tuesday 3:30 – basic group begins April 1
Wednesday 3:30 – comprehensive group begins April 3
If you are interested please fill out the attached form and hand in to septa mailbox at the administration office. For additional information please visit
www.lifesjourneyet.org or call Faith Custer at 735-4563
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SEPTA Participant’s Application
Participant Name:________________________________________DOB_____________________
Weight:__________ Age:__________ Gender: M___F___ Home # ________________________
Address: ______________________________City:_______________State:_______Zip:________
Parent/Guardian Name: 1. _______________________________Relation:___________________
Work # ________________________Email:______________________
2. _______________________________Relation:___________________
Work # ________________________Email:______________________
Participant’s Classification:_____________________________________________________________
Describe abilities/difficulties in the following areas (include assistance/equipment required)
Physical Function (Mobility skills such as transfers, walking, wheelchair use) ____________________________________________________________________________________________________________________________________________________________
Psycho/Social Function (Work/School including grade completed, leisure interests, relationships-family structure, support systems, fears/concerns, etc.) ____________________________________________________________________________________________________________________________________________________________
Goals (Why are you applying to participation? What would you or your child like to accomplish?) ____________________________________________________________________________________________________________________________________________________________
I would like to enroll in a ___basic group lesson ___comprehensive group lesson
I would prefer to ride on ___ Tue ___Sat ___Wed
PLEASE READ THE FOLLOWING AND INITIAL BEFORE SIGNING
PHOTO RELEASE: I hereby ___give permission ___do not give permission for images of myself and/or my child, captured during therapeutic riding sessions, through video, photo and digital camera, to be used solely for the purposes of Life’s Journey and Silver Rock Farm promotional material and publications, and waive any rights of compensation or ownership thereto. _________Initials
LIABILITY RELEASE: I acknowledge the risks and potential for risks of horseback riding, and hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Life’s Journey/Silver Rock Farm and SEPTA, its Board of Directors, Instructors, Aides, Volunteers, and or Employees for any and all injuries incurred while participating in a Life’s Journey Equine Therapy Program. ________Initials
MEDICAL RELEASE: (Only for individuals classified Learning Disabled, all other classifications must provide a signed medical history and physician’s statement available from www.lifesjourneyet.org)I am aware of certain precautions and contraindications to riding (see Health Care Provider cover letter under Registration Forms at www.lifesjourneyet.org
) and state that my child is currently in good health and I know of no medical reasons why they cannot participate. ______InitialsSignature:________________________________________________ Date: ________________
(parent/guardian if under 18 years of age)
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Our insurance policy and designation as a North American Riding for the Handicapped Association member center requires that we publish and adhere to a basic set of rules for our program. These rules are listed below for your information. Retain the top portion for your future reference, but sign and return the bottom section with other required forms to indicate that you have read and will abide by the following rules.
1. Forms and payment: We must receive all paperwork and fees before rider can
participate in a lesson.
2. Age and weight: According to NARHA guidelines riders must be 4 years or older. Due to the size of our horses we must restrict the weight of our riders to 200 pounds. Non-riding programs are available to individuals exceeding weight limit.
3. Clothing: Individuals should come to lessons with the following items;
An American Society for Testing Materials (ASTM-SEI) approved helmet (some are available at stable)
Long pants
Closed shoes, preferably with a heal
4. Arrival Time: Please plan to arrive for lesson 5 minutes before your assigned time. A rider that arrives consistently late may forfeit their lesson.
5. Inclement weather: A message will be posted on the telephone (845) 620-3780 regarding any weather related cancellations, but please note that lessons usually are held rain or shine.
6. Make ups: We will provide one make up lesson for each session only if you notify us at least 24 hours in advance of your scheduled time and have a legitimate reason for missing the lesson.
7. Information update: Please let us know immediately if there is any change in a participant’s condition.
8. All children must be monitored at all times: Siblings or friends of students who cause a distraction or problem will be asked to leave.
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Please cut here, keep the top part for your records and return bottom portion.
I have read and understand the basic rules under which Life’s Journey Equine Therapy operates, and by my signature indicate my willingness to abide by these rules:
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Participant’s Name
_______________________________ ___________________________ __________
Parent/Guardian’s Signature Printed Name Date
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FOR OFFICE USE ONLY
_____ Basic rules __ ___Equine Liability Waiver __ ___Photo/Release __ ___Participant Application
_____Emergency Treatment Release _____Medical History & Physician’s Statement : _____date ____________Payment
Interview Ride ____required ____not required If required when scheduled _____________________________________
Requested lesson ____group ___private ________day _________time