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Waiver for Intern Clearances
RELEASE AND HOLD HARMLESS AGREEMENT: The program at SPECIAL EQUESTRIANS provides Therapeutic Riding, Occupational Therapy, Physical Therapy, Therapeutic Horsemanship, Equine Facilitated Psychotherapy, and Group Programming for children and adults with disabilities. Volunteers and horses are carefully selected and trained, and safety equipment is required for all clients/riders since horseback is a risk exercise. No participant will be accepted for riding services and no volunteer accepted for service until this form has been READ, UNDERSTOOD, COMPLETED AND SIGNED by the parent(s) or guardian(S) of a minor, or if the participant or volunteer is of legal age and sound mind, by the participant or volunteer. Although participation in the program is under strict supervision and every effort is made to avoid injury or accident, the undersigned acknowledges the inherent risks involved in riding and working around horses. This includes bodily injury from horseback riding or being in close proximity to horses. Among other risks, both horse and rider can be injured in normal use or in competition and schooling. I acknowledge the risks and potential for injury that may occur with the activities of horseback riding and working around horses, and I have discussed these risks with my child/and his/her/my physician. However, I feel that the possible benefits to myself/son/daughter/ward are greater than the risk assumed. I grant SE permission to seek emergency medical care if needed. Therefore I agree to be legally bound for myself (or for my son/daughter/ward) heirs, executors or administrators and do hereby agree to release, hold harmless and indemnify SPECIAL EQUESTRIANS, its Board of Directors, Instructors, Therapists, Aides, Volunteers, Employees and the Township of Warrington, its Employees, Supervisors and Associates harmless of any claim for loss, injury or damages of every kind and nature whatsoever while at the SPECIAL EQUESTRIANS facility located on 2800 Street Rd. in Warrington, PA 18976 or while off the property in conjunction with a SPECIAL EQUESTRIANS event or show. I understand and agree that SE, at all times, has active surveillance and audio cameras on site in all public and common areas of SE. I understand that the purpose of this surveillance is to protect the safety and security of the clients, employees, volunteers, horses, and property of SE, and I therefore waive any expectation of privacy while in the common areas of SE, including my ability to sue SE for invasion of privacy, defamation, emotional distress or any other claim relating to my being recorded. Any audio or videos captured by the surveillance cameras are exclusively the sole property of SE. By entering the premises of SE, I consent to being recorded by the surveillance cameras, and I release SE from any claims arising out of the use of these surveillance systems. Special Equestrians shall preserve and respect the right of confidentiality for all individuals in our Therapeutic Riding, Occupational Therapy, Physical Therapy, Therapeutic Horsemanship, Equine Facilitated Psychotherapy, and Group Programs. The volunteers and staff of Special Equestrians must keep confidential any and all medical, social, referral, personal, and financial information regarding individuals and their families in our program. The Executive Director of the program will address any breach of confidentiality. I understand and agree to abide by the confidentiality policy of Special Equestrians. By signing this waive, I accept that I have read and understood the Release and Hold Harmless Agreement, Photo/Website Release, Confidentiality Agreement and Special Equestrians Policy.
RELEASE AND HOLD HARMLESS AGREEMENT: The program at SPECIAL EQUESTRIANS provides Therapeutic Riding, Occupational Therapy, Physical Therapy, Therapeutic Horsemanship, Equine Facilitated Psychotherapy, and Group Programming for children and adults with disabilities. Volunteers and horses are carefully selected and trained, and safety equipment is required for all clients/riders since horseback is a risk exercise. No participant will be accepted for riding services and no volunteer accepted for service until this form has been READ, UNDERSTOOD, COMPLETED AND SIGNED by the parent(s) or guardian(S) of a minor, or if the participant or volunteer is of legal age and sound mind, by the participant or volunteer. Although participation in the program is under strict supervision and every effort is made to avoid injury or accident, the undersigned acknowledges the inherent risks involved in riding and working around horses. This includes bodily injury from horseback riding or being in close proximity to horses. Among other risks, both horse and rider can be injured in normal use or in competition and schooling. I acknowledge the risks and potential for injury that may occur with the activities of horseback riding and working around horses, and I have discussed these risks with my child/and his/her/my physician. However, I feel that the possible benefits to myself/son/daughter/ward are greater than the risk assumed. I grant SE permission to seek emergency medical care if needed. Therefore I agree to be legally bound for myself (or for my son/daughter/ward) heirs, executors or administrators and do hereby agree to release, hold harmless and indemnify SPECIAL EQUESTRIANS, its Board of Directors, Instructors, Therapists, Aides, Volunteers, Employees and the Township of Warrington, its Employees, Supervisors and Associates harmless of any claim for loss, injury or damages of every kind and nature whatsoever while at the SPECIAL EQUESTRIANS facility located on 2800 Street Rd. in Warrington, PA 18976 or while off the property in conjunction with a SPECIAL EQUESTRIANS event or show. I understand and agree that SE, at all times, has active surveillance and audio cameras on site in all public and common areas of SE. I understand that the purpose of this surveillance is to protect the safety and security of the clients, employees, volunteers, horses, and property of SE, and I therefore waive any expectation of privacy while in the common areas of SE, including my ability to sue SE for invasion of privacy, defamation, emotional distress or any other claim relating to my being recorded. Any audio or videos captured by the surveillance cameras are exclusively the sole property of SE. By entering the premises of SE, I consent to being recorded by the surveillance cameras, and I release SE from any claims arising out of the use of these surveillance systems. Special Equestrians shall preserve and respect the right of confidentiality for all individuals in our Therapeutic Riding, Occupational Therapy, Physical Therapy, Therapeutic Horsemanship, Equine Facilitated Psychotherapy, and Group Programs. The volunteers and staff of Special Equestrians must keep confidential any and all medical, social, referral, personal, and financial information regarding individuals and their families in our program. The Executive Director of the program will address any breach of confidentiality. I understand and agree to abide by the confidentiality policy of Special Equestrians. By signing this waive, I accept that I have read and understood the Release and Hold Harmless Agreement, Photo/Website Release, Confidentiality Agreement and Special Equestrians Policy.
Check here to show you accept the terms stated above for yourself or for a minor volunteer for which you are a parental guardian.
