Application and Release Forms

We are so excited to partner with you at Ride to Fly.  Please fill out all sections to the best of your ability. The minimum student age is 4 years and there is no maximum age. If you have any difficulty in completing this form or have any questions, please reach out to us here: Contact Us

Contact Information

Services Selection

We invite you to select the services you are interested in attending. Below, you will find a detailed description of the various services we offer. Please take a moment to review them, as this will help you make an informed choice based on your preferences and needs.

Therapeutic Riding (TR) is recreational horseback riding adapted to individuals with disabilities. The instructor will collaborate with the participant to create a goal for the participant that is focused on developing a riding skill. There are many other benefits to TR including improvement in physical strength, balance, flexibility, motor planning, motor control, social emotional learning, sensory processing, and cognitive functioning.

Equine Assisted Learning Lessons (EAL) is the broad area of learning incorporating equines. The instructor provides an environment integrating equine-human interaction, supported by a planned learning experience, to meet identified goals for the participant. EAL can be used to address an endless multitude of non-riding skills in areas of social emotional learning, mental well-being, and cognition. Benefits include improvement in life skills, creative and critical thinking, self-awareness and empathy, communication and interpersonal skills, and coping with emotions and stress.

LIABILITY RELEASE

I acknowledge that the above participant would like to participate in the Ride to Fly program. I acknowledge the risks and potential for risks of horseback riding. However, I feel that the possible benefits to myself/my child/ward are greater than the risk assumed.

PHOTO RELEASE

I consent to and authorize Ride to Fly to use and reproduce any photographs and audiovisual materials taken of me/my child/ward. This permission includes the use of these materials for promotional printed materials, educational activities, or any other purpose that benefits the program.

THERAPEUTIC HORSEBACK RIDING PROGRAM PARTICIPANT RELEASE AGREEMENT

I understand that there are risks and dangers inherent in participating and/or receiving instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding, transporting, or riding horses and/or ponies, and in being in close proximity to such animals. I also understand that in order to be allowed to participate and/or receive instruction in the Ride to Fly therapeutic horseback riding or related activities, and/or in caring for, feeding, transporting, or riding horses and/or ponies, and in being in close proximity to such animals, I must give up my rights to hold the Ride to Fly organization or any associated stable, facility, or organization liable for any injury or damage which I may suffer while participating and/or receiving instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding transporting, or riding horses and/or ponies, and in being in close proximity to such animals.

Knowing this, and in consideration of being permitted to participate and/or receive instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding, transporting, or riding horses and/or ponies, and in being in close proximity to such animals, I hereby voluntarily release the Ride to Fly organization and any associated stable, facility, or organization from any and all liability resulting from or arising out of my participation and/or receipt of instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding, transporting, or riding horses and/or ponies, and being in close proximity to such animals.

I understand and agree that I am releasing not only the entities set forth in the paragraph above, but also the officers, agents, and employees of those entities.

I understand and agree that this Release will have the effect of releasing, discharging, waiving, and forever relinquishing any and all actions or causes of action, including action for negligence, that I may have or have had, whether past, present or future, whether known or unknown, and whether anticipated or unanticipated by me, arising out of my participation and/or receipt of instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding, transporting, or riding horses and/or ponies, and in being in close proximity to such animals. This Agreement constitutes a complete release, discharge, and waiver of any and all actions of causes of action against Ride to Fly, and its officers, agents, employees, and against any associated stable, facility, or organization, and their officers, agents, and employees.

I understand and agree that this Release applies to personal injury, property damage, or wrongful death which I may suffer, even if caused by the act or omissions of others.

I understand and agree that by signing this Release, I am assuming full responsibility for any and all risk of death or personal injury or property damage suffered by me while participating and/or receiving instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding, transporting, or riding horses and/or ponies, and in being in close proximity to such animals.

I understand and agree that this Release will be binding on me, my spouse, my heirs, my personal representatives, my assigns, my children, and any guardian ad litem for said children.

I understand that if I were to file a lawsuit against any of the above named entities, or any of their officers, agents, or employees as a result of any personal injury or property damage suffered by me while participating and/or receiving instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding, transporting, or riding horses and/or ponies and in being in close proximity to such animals, that this Release would operate to bar that lawsuit and that the lawsuit would be dismissed by the court on the grounds that I have expressly assumed the risks associated with participation and/or receipt of instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding, transporting, or riding horses and/or ponies, and in being in close proximity to such animals. I understand and agree that by signing this Release, I am agreeing to release, indemnify and hold Ride to Fly and its officers agents, and employees harmless from any and all liability or costs, including attorneys’ fees, associated with or arising from my participation and/or receipt of instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for feeding, transporting or riding horses and/or ponies, and in being in close proximity to such animals.

I understand and agree that if I am signing the Release on behalf of my minor child/ward, that I will be giving up the same rights for said minor as I would be giving up if I had signed this Release on my own behalf.

I acknowledge that I have read this Release Agreement and that I understand the words and language in it. I have been advised of the potential dangers incidental to participating and/or receiving instruction in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding, transporting, or riding horses and/or ponies, and in being in close proximity to such animals. Large animals can cause injury, death, or damage due to their size and temperament.

I acknowledge that I am aware of and assume all risks noted above and that I wish to participate in the Ride to Fly therapeutic horseback riding program or related activities, and/or in caring for, feeding, transporting or riding horses and/or ponies, and in being in close proximity to such animals. To the extent that I participate in such activities, I do so voluntarily and I assume full responsibility for any loss and/or inconvenience resulting from an injury to myself, my minor child/ward, and or my property resulting therefrom.

PRIVACY POLICY

Ride to Fly is committed to respecting your privacy, and recognizes the need for appropriate protection and management of any personally identifiable information that is shared with us. Personal Information means any information that may be used to identify an individual, including, but not limited to, a first and last name, personal profile including medical history, a home or other physical address and an email address or other contact information, whether at work or at home. Personal information is collected from applications submitted to Ride to Fly. The following are our business practices (not a contract), and they may be updated by us.

OUR POLICIES AND PRACTICES ON DISCLOSING NON-PUBLIC PERSONAL INFORMATION

We do not disclose non-public personal information (medical, financial or other sensitive information) about our clients or volunteers to unrelated third parties except as permitted by law, and/or if authorized by our client or volunteer.

We may need to disclose non-public personal information to our instructors and select volunteers involved with the teaching of a client. This information will remain completely confidential. These disclosures may be made for the purpose of performing administrative services or for providing the specific procedures to achieve the best results for our client. We may also disclose non-public personal information when required to do so by law, court order, subpoena, other legal process, or as requested by a governmental agency or law enforcement authority.

All written materials in the client/volunteer files will be maintained in confidence and not removed from said files. We maintain physical, electronic and procedural safeguards that comply with federal and state regulation to guard your non-public personal information.

I understand/will observe the privacy and confidentiality policy of Ride to Fly.

By typing my full name below I (participant if 18 or older, or parent/guardian) understand/will observe the privacy and confidentiality policy of Ride to Fly:

RIDE TO FLY PARTICIPANT ACKNOWLEDGMENT OF RISK: COVID-19

By typing my full name below, I (participant if 18 or older, or parent/guardian)  acknowledge that I am aware of the risks of contracting Covid-19 while receiving in-person services from Ride to Fly at this time of the pandemic outbreak. I acknowledge that certain at-risk populations such as persons over age 60, those with underlying medical conditions such as diabetes, hypertension, respiratory issues, or obesity are more susceptible to the disease, and I knowingly accept the risk of potentially catching Covid-19 despite reasonable precautions. I am also aware that face to face services increase my risk of contracting and passing on the Covid-19 or Coronavirus. Ride to Fly cannot guarantee social distancing in cases of needing assistance to mount/dismount, emergencies, or other unforeseen events and that I may be exposed despite the best efforts of Ride to Fly. I agree to hold harmless Ride to Fly, it’s employees, and all other individuals I may come in contact with during this interaction and receiving of services. I agree and will follow all guidelines for standard precautions, personal safety, and public safety as recommended by Ride to Fly and the Los Angeles County Health Department. I agree to cancel my services should I have personally exhibited or have been in contact with someone who has presented with symptoms of illness including; coughing, sneezing, fever, shortness of breath or difficulty breathing or additional signs of the potential spread of any virus or bacteria/disease such as chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose within the previous 2 weeks. Ride to Fly will engage in regular cleaning and sanitizing of horse tack, grooming supplies, and frequently touched areas in-between clients and on a daily basis as recommended by the CDC and by Los Angeles County Health Department for the safety of clients, employees, volunteers, and horses.

A detailed policy and procedure document can be found on our website.

MANDATORY ADDITIONAL FORMS

We require that the following forms are completed, signed, and returned to Ride To Fly.

The student's physician must fill out and sign our Medical History & Physician's Statement. Please download the:

 Medical History & Physician's Statement here. 

The Ride To Fly code of conduct form: 

Code Of Conduct 

The Ride To Fly New Quarter Agreement:

New Quarter Agreement

Applications are not complete until all MANDATORY ADDITIONAL FORMS have been submitted. All three of the above documents need to be completed and sent to the following email address: shoffman@ridetofly.org

DOCUMENT SIGNATURE