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Dear Parents, Participants, or Caregivers,
Welcome to Freedom Hooves Therapeutic Riding Center. We look forward to having you participate
in our riding program. FHTRC provides therapeutic riding to all disabled individuals who can benefit
from this unique and valuable form of therapy. Please read through all the information in this packet
thoroughly. It contains very important information regarding registration of your rider and participation
in the program at FHTRC.
We are currently taking applications for our therapeutic riding program. We have limited riding times
and spots fill up fast so get your paperwork in quickly!
One of our goals at FHTRC is to keep our program affordable to all our participants and families. To
make this possible we have several fundraising events and activities throughout the year. We also
constantly look for grants, donations, and corporate sponsorships for our program and events. At
FHTRC we never want to turn anyone away from our program because of their financial situation.
Therefore, we are always looking for help from all our families and volunteers with our fundraising
efforts and events.
We are very proud of our program and its accomplishments throughout these past years! We would not
be where we are without the support of our wonderful riders, families, board members, donors, and
sponsors. Thank you for your interest in our program and we look forward to having you as part of our
Freedom Hooves family.
Thank you,
Amanda Hale
Amanda Hale
Executive Director
PATH Intl. Certified Instructor
www.FHTRC.org
316-733-8943
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
__________________________________________________________________
1.Getting Started
First please complete all paperwork included in this packet. Then either mail (FHTRC, P.O. Box 782622,
Wichita, KS 67278) or scan and email ([email protected]) your completed paperwork in to FHTRC. Once you
completed your paperwork please contact (316) 733-8943, to schedule your evaluation (new participants) or
riding time (returning participants). If you are a returning participant your reevaluation, if needed, will be
completed during your first riding session. All new participants need to schedule a separate evaluation. There
will be a $15 evaluation fee for therapeutic riding participants.
2. Programs
FHTRC offers therapeutic riding sessions and group sessions. Riding time: Each participant’s session will last
30 minutes. This includes mounting and dismounting times for the participant. We allow approximately 5
minutes for mount and dismount which allows each participant approximately 25 minutes on the horse. It is up
to the instructor’s discretion to decrease the time of a session for any reason including the following: client
fatiguing, client medical problems, client complaining of discomfort, client behavior problems, horse fatiguing
or other horse related problems. If a horse problem occurs, we will attempt to complete your session time on
another horse. We want our sessions to be a positive experience for both our horses and all our clients.
***We would highly encourage all parents to attend a volunteer training. Because our program relies
heavily on volunteers there is always a chance that we may have volunteer no shows or cancellations. It is
very helpful to the FHTRC staff to know that we have trained parents able to step in for absent volunteer and
this will also enable your rider to continue with their mounted session as planned. Volunteer training dates are
posted on our website at www.fhtrc.org. If there are NOT enough volunteers to conduct a safe riding lesson a
ground/grooming lesson may be offered in place of the riding session.
Therapeutic Riding Program: Therapeutic Riding participants are scheduled to ride once a week for 30 minutes.
Riding participants must be at least 4 years old. All therapeutic riding participants are instructed by PATH
Intl. Certified Riding Instructors. At FHTRC we have found that our clients improve the most with one on one
attention. Therefore, we mainly offer private lessons with one instructor teaching one client. We do have group
lessons if desired. Goals for therapeutic riding focus on horsemanship skills, educational skills, and leisure
activities. Participants are screened by a certified instructor and their programs are periodically reviewed by the
instructor for changes.
3. Participant Dismissal and Discharge Policy
It is at the discretion of FHTRC’s Executive Director and Program Director to accept or remove a participant
from the program. The results of a risk/benefit analysis will also be considered. Participants who do not adhere
to the rules and procedures or meet the guidelines for eligibility are subject to dismissal or discharge. Possible
grounds for dismissal may include, but are not limited to: conduct endangering another participant, volunteer,
staff member, or horse, conduct endangering themselves, consistent failure to follow safety procedures with
respect to the horses, a gain in weight above the FHTRC maximum levels, failure to cancel in advance for more
than three lessons, or incomplete paperwork. The development of a contraindicated condition or the
deterioration of a condition to the point horseback riding is no longer beneficial or could be harmful to the
participant or where safety for the participant or others has become a concern.
Participant Handbook
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
Participants at FHTRC shall have no history of inappropriate behavior with fire or any tendencies or history of
abuse or violence directed toward animals or other people. FHTRC reserves the right to deny services to any
individual based upon concerns for the applicant’s safety and/or the safety of the horses, volunteers, staff,
property owners, or for other reasons in accordance with PATH Intl. operating center guidelines.
No participant will be dismissed without an opportunity to discuss the reasons with supervisory staff. The
participant may at any time, for whatever reason, decide to sever the participant relationship with FHTRC.
Notice of such a decision should be communicated as soon as possible.
4. Weight Limitations for All Participants
Maximum weights are listed below, but decisions regarding participation will be based on the availability of a
suitable horse related to the height, weight, cognition, and balance of the participant. Decisions will also be
based on the availability of tall and/or strong volunteers. Weights include the weight of the client plus the
saddle/tack.
• 220lbs. for a well balanced centered rider not requiring sidewalkers
• 180lbs. for an unbalanced rider needing sidewalker assistance
• Each horse has an individual weight limitation based upon the horse’s height, weight, age, and physical
and medical condition
5. Scheduling of a Weekly Riding Time for New Participants
Once the initial evaluation is completed, we will then see if we have a current opening in the FHTRC schedule
that is suitable to meet your participant’s needs. If an opening does not currently exist then we will put your
participant on a waiting list and you will be notified as soon as an opening becomes available. Riding sessions
are typically offered throughout the day and early evening on Monday through Thursday. We do not have
weekend sessions, as we like to leave the arena open to other boarders at the boarding facility. Available riding
times will be discussed at your evaluation.
6. Billing
Therapeutic Riding Lessons are billed on a sliding scale fee per 30-minute ride and will be billed in 8-week
sessions prior to the beginning of the session. If a payment plan is needed please contact the Executive Director
to discuss payment options.
Any participant with an outstanding balance from the previous session will not be allowed to ride until
the balance on the account has been paid or payment arrangements have been made.
7. Cancellations
If FHTRC should cancel a riding session (due to weather or instructor illness, etc.):
• Your fees will be credited toward the next 8 week session
• You will be notified by phone, email, and/or text message for cancellations
• FHTRC will cancel if the wind chill is below 40 degrees or the heat index is above 95 degrees.
• FHTRC will also cancel in cases of extreme weather such as thunderstorm and tornado watches and
warnings, and extremely high winds
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
If you cancel a riding lesson: You will not be billed for cancelled lessons IF 24 hours notice is given. We
need time to contact volunteers if their client cancels, so please contact the instructor and give notice if you
need to cancel.
FHTRC running late: Any time FHTRC program is running late (as we will at times) we will do our best to get
back on schedule, however, we will offer the participant their full lesson time. We will attempt to notify you
upon arrival regarding the length of wait before your participant will ride.
Participant tardiness: Any time a participant is late, their session time will be decreased accordingly in order for
the schedule to remain intact. If a participant is 15 or more minutes late for a session they will NOT be
allowed to ride for that lesson. We will do our best to provide other activities for the client to participate in
while at the barn, such as grooming.
Make-Up lessons: Make up times are set on Monday’s from 1:00pm-2: 30pm and are on a first come, first serve
basis and volunteer availability. If this does not work for you, another riding time may be able to be worked out.
There is no guarantee because our riding schedule is very full. Only participant cancelled lessons are eligible to
be made up. If a participant is a no-show (no previous notice given), this lesson will not be eligible to be made
up.
8. Scholarships
FHTRC offers full and partial scholarships to all those who need them if funds are available. Scholarship levels
will be approved according to each family’s or participant’s financial needs. We require that all those
requesting a scholarship write a detailed letter to FHTRC stating their financial situation with proof of their
financial need. We also require that all parents/families that participate in the scholarship program assist during
the year with 1-2 fundraising activities that help keep the program affordable to all of our participants. We will
provide a discount form at your request during the initial evaluation along with a list of volunteer activities for
your review (these will include activities that can be completed at the barn or at home). FHTRC has also
instituted a discounted service plan for those that help to raise funds for FHTRC or those that volunteer for
FHTRC.
9. Attire
No open toe shoes, sandals, or clog type shoes. No slick (jogging type) pants. We would prefer that your
participant wore pants instead of shorts, as the saddle can get very uncomfortable with direct skin contact.
10. Children
We ask that children be monitored and in direct vision of the adult at all times while at the facility. Please
review the barn rules with your children prior to arriving at the barn.
11. Dogs and Other Animals
Do not bring dogs or other animals to the barn with you at any time. The exception to this rule is service
animals. Please let your instructor know if you will be bringing a service animal to the lesson with you.
12. Riding Helmets
All clients must wear riding helmets that meet or exceed ASTM regulations. Helmets are provided by FHTRC
for class use, or you may purchase your own individual helmet.
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
13. Observing Therapy Sessions
Families, siblings, and friends of our clients are welcome to observe the session as long as it does not distract
the client or the horse. We do have a small area with chairs for you. If at any time the instructor feels that the
client is too distracted by observers they may ask them to wait in the office area. We want all of our clients to
get the most they can out of every lesson.
14. Speed Limit
The speed limit at the ranch is 15 mph. This is enforced at all times even if you are running late to a session. If
you continue to not obey the speed limit, you will not be allowed on the ranch anymore. This is the barn
owner’s policy and we support it as we have clients and other boarders riding down the road at times.
15. Communication/ Questions
Email is an inexpensive and convenient way for us to contact you about class cancellations, session information
and program events. It is important that you provide us with an email address that you check frequently.
Please direct questions to your participant’s instructor. If you do not get a satisfactory answer to your question
please feel free to contact the Executive Director at (316) 733-8943.
Thank you very much for your interest in our program. We look forward to working with you this year. Our
goal is to provide a safe atmosphere that allows our clients to have fun and enjoy their time on horseback.
I can be reached, and communicate best, through email at [email protected]. I can also be reached at (316)
733-8943.
Thank you,
Amanda Hale
Amanda Hale
Executive Director, FHTRC
P.O. Box 782622 Wichita, KS 67278
Phone: 316-733-8943
NEW Start date: _______
Returning Orig. Date: _________ Return Date: _______
Physician: Date: ________
Emergency Authorization Treat No Treat
Liability Release
Photo: Yes No
INITIAL: _____ DATE: ___ Office Use Only
Student Application and Emergency Contact Information
GENERAL INFORMATION
Participant’s Last Name: ________________________________ First name: __________________________
Address: ________________________________________ City: _________________ Zip: _______________
Phones: Home: ________________________ Cell: _______________________Work: ___________________
Text notifications for cancellations or important information
E-mail Address: _________________________________________________________________
Please include an email address that you check frequently. Email is a convenient and inexpensive way for us to contact you.
We would like to use it to alert you of cancelations, session information and program events.
DOB: _______________Age: _____ Height: ________ Weight: __________ Gender: M F
School or Employer: ___________________________________________ Phone: ______________________
Teacher: ________________________________________________ Phone: ___________________________
How did you come to know about our program? __________________________________________________
Did you attend Freedom Hooves Therapeutic Riding Center in the past: Yes: _______ No_______
Mother’s/Guardian Information:
Name: _______________________________________ Mailing Address: ______________________________
City: _______________________ State: _______ Zip: __________ Email: _____________________________
Phone #s: Cell: ______________________ Home: ______________________ Work: ____________________
Place of Employment: ______________________________ Occupation: ______________________________
Best way to get a hold of you (Please Circle one): Email Cell Phone Text Message Home Phone Work Phone
Father’s Information:
Name: _______________________________________ Mailing Address: ______________________________
City: _______________________ State: _______ Zip: __________ Email: _____________________________
Phone #s: Cell: ______________________ Home: ______________________ Work: ____________________
Place of Employment: ______________________________ Occupation: ______________________________
Best way to get a hold of you (Please Circle one): Email Cell Phone Text Message Home Phone Work Phone
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
Student Application and Health History – Page 2
Individual Responsible for Payment Information:
Name: _______________________________________ Mailing Address: ______________________________
City: _______________________ State: _______ Zip: __________ Email: _____________________________
Phone #s: Cell: _______________Home: __________________Relationship to Participant: _______________
Caregiver name (if applicable): ______________________________Phone #: _________________________
Emergency Contact: ________________________ Relation: ______________ Phone: ____________________
Emergency Contact: ________________________ Relation: ______________ Phone: ____________________
Physician’s Name: ___________________________________ Phone: ________________________________
Preferred Medical Facility: ___________________________________________________________________
Health Insurance Company: ______________________________ Policy #_____________________________
Health History
Allergies: ___________________________ Current Medications: ____________________________________
Significant Medical History: __________________________________________________________________
Diagnosis: ________________________________________________ Date of Onset: ____________________
Please indicate current or past needs in the following areas:
Yes No Comments
Vision
Hearing
Sensation
Communication
Heart
Breathing
Digestion
Elimination
Circulation
Emotional/Mental
Health
Behavioral
Pain
Muscular
Thinking/Cognition
Bone/Joint
Allergies
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
Student Application and Health History – Page 3
Please answer each question to the best of your ability. We use all this information to develop lesson plans and
goals for you or your rider. Please attach a separate sheet with more details if needed.
Medications
Name Prescription Over the Counter Dose Frequency
Other Current Therapies and Frequency:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Physical Function
Describe abilities/difficulties in the following areas (include assistance required or equipment needed). For
example: Mobility skills such as transfers, walking, wheelchair use, driving/bus riding
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Psycho/Social Function: (e.g. work/school- including grade completed, leisure interests, relationships, family
structure, support systems, companion animals, fears, concerns, emotional struggles, etc.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Goals: Why do you want to be a student at Freedom Hooves Therapeutic Riding Center? What would you like
to accomplish? (Balance, independence, etc.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
PHOTO RELEASE
I DO I DO NOT
Consent to and authorize the use and reproduction by FREDOOM HOOVES THERAPEUTIC RIDING
CENTER of any and all photographs and any other audio/visual materials taken of me for promotional material,
educational activities, exhibitions or any other use for the benefit of the program.
Signature: Student (if over 18): ___________________________________________________
Signature: Parent or Legal Guardian: ________________________________________________
Date: ____________________________________
Physician’s Form Page 1
P.O. Box 782622 Wichita, KS 67278 Phone: 316-733-8943
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
INFORMATION FOR PHYSICIAN
Dear Health Provider:
Your patient, ______________________________, is interested in participating in supervised equine activities.
In order to safely provide this service, our center requests that you complete/update the attached Medical
History and Physician’s Statement Form. The following conditions, if present, may represent precautions or
contraindications to therapeutic horseback riding. Therefore, when completing this form, please check which of
these conditions are present, and if so, to what degree:
ORTHOPEDIC
☐Atlantoaxial Instability (including neurologic
symptoms)
☐Coxa Arthrosis
☐Heterotopic Ossification/ Myositis Ossificans
☐Joint Subluxation/ Dislocation
☐Osteoporosis
☐Pathologic Fractures
☐Spinal Joint Fusion/ Fixation
☐Spinal Joint Instability/ Abnormalities
☐ Cranial Deficits
NEUROLOGIC
☐Seizure Disorders
☐Spinal Bifida
☐Chiari II Malformation
☐Tethered Cord
☐Hydromyelia
☐Hydrocephalus/Shunt
☐ None of these conditions are present
MEDICAL / PSYCHOLOGICAL
☐Allergies
☐Animal Abuse
☐Cardiac Conditions
☐Physical/Sexual/Emotional Abuse
☐Blood Pressure Control
☐Dangerous to self or others
☐Exacerbations of medical conditions (i.e. RA, MS)
☐Fire Settings
☐Hemophilia
☐Medical Instability
☐Migraines
☐PVD
☐Respiratory Compromise
☐Recent Surgeries
☐Substance Abuse
☐Thought Control Disorders
☐Weight Control Disorder
OTHER
☐Age – Under 4 years
☐Indwelling Catheters / Medical Equipment
☐Medication – i.e. photosensitivity
☐Poor Endurance
☐Skin Breakdown
Treating Physician Signature: ________________________________ Date: ________________________
Treating Physician Name (please print): __________________________ Date: ______________________
Thank you very much for your assistance. If you have any questions or concerns regarding this patient’s
participation in equine assisted activities, please feel free to contact me at (316) 733-8943.
Sincerely,
Amanda Hale
Physician’s Form Page 1
P.O. Box 782622 Wichita, KS 67278 Phone: 316-733-8943
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
Amanda Hale
FHTRC Executive Director
SEIZURE DISORDER PARTICIPANTS – If Client does not have seizures write N/A
PATH (Professional Association of Therapeutic Horsemanship Association) recommends the following
information for PATH Operating Centers for clients with seizure disorders:
Would you consider ____________________________________________’s seizures to be: (please rate)
(name of participant)
□ Completely controlled □ Very well controlled □ Fairly controlled by medication
Type of Seizure:
Typical Seizure:
Typical motor activity during seizure:
Description of client’s behavior during post-ictal state: Post-ictal state duration:
Specific directions as to what to do if a seizure should occur at Freedom Hooves Therapeutic Riding Center:
Physician’s Signature: Date:
P.O. Box 782622 Wichita, KS 67278 Physician’s Form Page 3 Phone: 316-733-8943
PARTICIPANT’S MEDICAL HISTORY & PHYSICIAN’S STATEMENT
Participant: ________________________________DOB: ________Height: ________ Weight: ______
Address: _____________________________________________________________________________
Diagnosis: ____________________________________Date of Onset: ____________________________
Past/Prospective Surgeries: ______________________________________________________________
Medications: __________________________________________________________________________
Shunt Present: Y N Date of Last Revision ________________________________________________
Special Precaution/Needs: _______________________________________________________________
_____________________________________________________________________________________
Mobility: Independent Ambulation: Y N Assisted Ambulation: Y N Wheelchair: Y N
Braces/Assistive Devices: ________________________________________________________________
For those with Down syndrome – AtlantoDens interval X-Rays: Date: ___________Result: Pos Neg PATH recommends within the past 5 years and review every year; Physician Discretion for repeat x-ray.
Neurologic Symptoms of Atlanto Axial Instability: ____________________________________________
Please indicate current or past special needs in the following systems/areas, including surgeries:
Yes No Comments
Auditory Visual
Tactile Sensation
Speech Cardiac
Circulatory Integumentary/Skin
Immunity
Pulmonary Neurological
Muscular Balance
Orthopedic
Allergies Learning Disability
Cognitive Emotional/Psychological
Pain
Other Other
To my knowledge, there is no reason why this person cannot participate in supervised equestrian activities. However, I understand
that the PATH center will weigh the medical information above against the existing precaution and contraindications. I concur with a
review of this person’s abilities/limitations by a licensed/credentialed health professional (e.g. PT, PT, SLP, Psychologist, etc) in the
implementation of an effective equine activity program.
Signature: ____________________________________ Date: _________________________________
Name: __________________________________________ Date: ________________________________
Address: ___________________________________________ Title: MD DO NO PA Other ________
Phone: ( ) ______________________________ License/UPIN Number: ____________________
P.O. Box 782622 Wichita, KS 67278 Phone: 316-733-8943
NO CALL/NO SHOW POLICY
WHEN YOU ENROLL AT FREEDOM HOOVES THERAPEUTIC RIDING CENTER, we schedule you on a
regular basis and a horse is prepared prior to each lesson. We also schedule staff and volunteers to meet the
need of the class (both in individual and group).
Please call 24 hours in advance if you will NOT be able to attend your lesson. This helps us to adjust our
program, volunteers and horses for the lessons if needed. If you cannot call 24 hours in advance, please make
sure you call by 8:00 a.m. We will take into consideration emergencies, but PLEASE CALL US.
If you are more than 15 minutes late for your scheduled class you will NOT be able to ride. Please arrive on
time. If you are consistently late we will need to discuss a different time that is more suitable.
If a student does not call and does not show up for class, a NO CALL/NO SHOW FEE of $15.00 will be
charged to the student for that day’s lesson. After three (3) No Call/No Shows you will be dropped from your
class and will have to re-register. If you are on a full or partial scholarship, you will have to reapply.
Thank you for informing us of your unavailability for your scheduled lesson.
We appreciate your understanding and support.
By signing below I agree that I have read and understand FHTRC’s No Call/ No Show policy.
Participant Name: _____________________________________________
Parent/Participant Signature: ______________________________ Date: ___________________
P.O. Box 782622 Wichita, KS 67278 Phone: 316-733-8943
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
FHTRC Therapeutic Riding Schedule
Please help us to serve you. If you could take a moment and answer the following questions based on your
preferences, we would greatly appreciate it. We are considering how to best make use of FHTRC’s time and
schedule while we seek to meet your needs as well.
Answer the following:
1) Would you prefer morning or evening classes? _________________________
2) What weekday works best for you?
☐MONDAY ☐ TUESDAY ☐ WEDNESDAY ☐ THURSDAY
3) Please list in order the three times of day that would work best for your schedule
P.O. Box 782622 Wichita, KS 67278
Phone: 316-733-8943
FREEDOM HOOVES THERAPEUTIC RIDING CENTER
Billing Policies
FHTRC is committed to providing a quality therapy experience at an affordable rate. The majority of incurred
expenses are financed through private donations, grants and fundraisers. While expenses have increased, we
strive to keep our fees as low as possible.
We determine payment for therapeutic riding based on income. If this payment does not fit into your budget
please indicate below that you are in need of a scholarship. FHTRC will do our best to provide a partial or full
scholarship as need arises.
Fees:
**FHTRC does not bill Insurance or Medicaid**
Evaluations: Evaluations are performed by one of the FHTRC certified instructors for all new participants
desiring to enter the program. Therapeutic Riding evaluation fees for new participants are $15.
Therapeutic Riding: We have a sliding scale fee based on your or family’s income level. Proof of income
level may be asked to submit prior to admittance into the therapy program. Please fill out the section below to
determine your level. Full payment is required prior to the start of the riding session unless other arrangements
have been made.
Scholarships: Scholarships are available if needed and if funding has been secured by FHTRC. Scholarships
are based on your annual income. If you do not qualify for a scholarship we also offer a discounted services
program, which is based on how many hours you volunteer for FHTRC or how much you help raise in
donations. If you need to request a scholarship or discounted services please write a letter to the program
explaining, in detail, your request including specific areas such as financial need, out of pocket expenses,
therapeutic benefits, or other necessary information. All scholarship applications are reviewed at the end of each
session by our scholarship committee. This committee is made up of members of the board of directors for
Freedom Hooves.
P.O. Box 782622 Wichita, KS 67278 Phone: 316-733-8943
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
PAYMENT AGREEMENT
Responsible Party for payment: _________________________________________________
Family’s Net Income: _________________________________________________________
Clients that can pay are asked to pay as much as they can. If you have any questions please call (316) 733-8943.
Client Name: _________________________________________ DOB ____________________
Sliding Scale Fees Please circle the best level for your income level and continue to the statements below
$85,000 + $55 per lesson
$64,500- $84,999 $45 per lesson
Less than $64,499 $35 per lesson
______ I agree to pay the amount listed on the sliding scale fee
_____ In order to participate in the FHTRC program, I am in need of a partial scholarship
______ In order to participate in the FHTRC program, I am in need of a full scholarship
By signing below I agree that I have read and understand FHTRC’s billing policies.
Participant Name: _____________________________________________
Parent/Participant Signature: ______________________________ Date: _______________________
P.O. Box 782622 Wichita, KS 67278 Phone: 316-733-8943
FHTRC P.O. Box 782622 Wichita, KS 67278 www.fhtrc.org (316) 733-8943
FREEDOM HOOVES THERAPEUTIC RIDING CENTER
Liability Release
As a volunteer/client/staff/student/board member at Freedom Hooves Therapeutic Riding Center I acknowledge
the risks of a horseback riding program. However, I feel the possible benefits to myself and the participants I
work with are greater than the risk assumed.
I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and
release forever all claims for damages against Freedom Hooves Therapeutic Riding Center, its’ Board of
Directors, Instructors, Therapists, Aides, Volunteers and/or Employees for any and all injuries and/or losses I
may sustain while participating in Freedom Hooves Therapeutic Riding Center program.
WARNING:
Under Kansas law, there is no liability for an injury to or the death of a participant in domestic animal activities
resulting from the inherent risks of domestic animal activities, pursuant to K.S.A. 60-4001 through 60-4004.
You are assuming the risk of participant in this domestic animal activity.
If client/volunteer is under 18 years of age, Parent/guardian must sign.
Name: (Please Print Clearly) _____________________________________________________
Signature: ________________________________________________ Date: ______________
Signature: ________________________________________________ Date: ______________
Parent/Guardian – if minor or legal guardian
D&J RANCH
RELEASE OF LIABILITY
KNOWING THAT RISK IS ALWAYS ATTACHED TO HORSEBACK RIDING AND IN CONSIDERATION OF THE SERVICES
RECEIVED AND BEING DESIROUS OF RECEIVING INSTRUCTION ON THE RIDING OF HORSES BY
______________________ (INSTRUCTOR). I _____________________________ (PARENT/GUARDIAN) OF
_________________________________________________________
I DO HEREBY RELEASE AND DISCHARGE SAID INSTRUCTOR & THE D & J RANCH (DANE AND JENNIFER WADLEY)
OF ANY AND ALL LIABILITY ARISING FROM THE RIDING AND/OR HANDLING OF HORSES UPON THE PREMISES
KNOWN AS THE D & J RANCH, INCLUDING BUT NOT LIMITED TO LESSONS AND/OR DEFECTS IN RIDING
EQUIPMENT (I.E. SADDLES, BRIDLES,ETC…).
I AGREE TO HOLD SAID INSTRUCTOR & THE D & J RANCH HARMLESS FROM ANY AND ALL CLAIMS AND
LIABILITY THAT MAY BE MADE BY MYSELF OR ANYONE ON MY BEHALF INCLUDING COSTS AND REASONABLE
ATTORNEY FEES.
THIS RELEASE IS BINDING UPON MY HEIRS AND ASSIGNS. _________________________
DATE__/__/___