Certified Therapeutic Riding Application

About Therapeutic Riding:

STAT Inc provides a broad range of equine assisted learning services to include Therapeutic Horseback Riding lessons. STAT's experienced riding instructors are certified by the Professional Association of Therapeutic Horsemanship (PATH) and are called Certified Therapeutic Riding Instructors (CTRI).

STAT provides therapeutic riding for people with mental health and physical challenges with varying ability levels to set goals to improve their quality of life while learning to connect with and ride a horse. STAT also provides traditional riding lessons to clients without mental health and physical challenges. Riding instructors and equine specialists at STAT support and facilitate these riding goals with each client. STAT provides quality riding instruction and adheres to PATH Intl's safety guidelines for a positive impact of the human/animal bond through offering effective equine-assisted activities and therapies.

Other Equine Assisted Programming Options at STAT

While it is important we understand a brief medical and behavioral health history for Therapeutic Riding, please note that Therapeutic Riding is not mental health treatment or physical therapy.

If the applicant's needs require additional Equine Assisted Learning (EAL) from a mental health facilitator and equine specialist team to help with behavioral and mental health needs apart from riding, we can discuss additional STAT EAL programming options with you. In some cases, it would be best to start with EAL and transition into Therapeutic Riding.

Additionally, you or your child may be referred to STAT Physical Therapist for Hippotherapy (Riding under guidance of a Physical Therapist) to address medical and behavioral health related disorders that are not an appropriate fit under Therapeutic Riding.

STAT's Safety Policy

Valley School Service Learning Program at STAT is a half-day of learning about caring for yourself, others, and horses. Small groups of 5 to 6 students with their amazing Teacher along with horses. Students will have an opportunity to take a brief optional horse riding lesson. Wear closed toed shoes: no sandals or flip flops.

Applicants: Are you a Veteran or Service Member or Immediate Family Member of a Veteran or Service Member?

VETERANS and Immediate Family members of Veterans: apply on our STAT Veteran Program application to receive classes at no cost thanks to the generosity of VA Adaptive Sports-22 Grant.

Or follow STAT's link https://hushforms.com/stat-veteran-programs

STAT honors Veterans and Service Members with $10 off their own lesson: $35 for 60 a minute lesson instead of $45.

Name of person completing this application:

*For Minor applicants and adult applicants with a legal guardian/guardianship must have legal guardian submit and attest to this application. Applications submitted by friends, family members, case managers, aides etc are not accepted.

Therapeutic Horse Riding Lessons at STAT

• Guardians/Parents STAY on the premises in designated areas while the child/minor is in a lesson.
• Therapeutic Riding lessons are 60 minutes and $45 paid at time of lesson for individuals with mental health and physical health challenges.
• Traditional Riding lessons are 60 minutes and $75 paid at the time of the lesson for applicant (without mental health or physical challenges).

Horseback Riding Experience

Applicant's Information

Emergency Contact information

Parent or Guardian Information

Medical & Behavioral Health History

Traditional Riding Lessons in STAT's Therapeutic Environment

STAT's Equine Services Liability and Confidentiality Form

STAT CONFIDENTIALITY AGREEMENT AND EQUINE ACTIVITY LIABILITY RELEASE AND RISK ACKNOWLEDGEMENT

I agree not to disclose any Client names, treatment information or identifying information pertaining to any Client, past, present or future, of STAT, Inc. to anyone apart from discussing my own/my child/children sessions or lessons with directly assigned STAT, Inc. Staff. This confidentiality agreement is effective the date of the signing of this agreement, and is forever binding after my association with STAT, Inc. ends.

1. PARTIES.

The parties to this document are Southern Tier Alternative Therapies, Inc. with equine operations at 24 Stom Road, Ligonier PA (hereinafter “STAT”) and CLIENT

2. APPORTIONMENT OF LIABILITY

In consideration of Client being allowed to attend, participate in, or observe activities sponsored or conducted by STAT, or be present on the property on which STAT conducts its activities, Client does agree to hold harmless and release STAT, its officers, members, managers, agents, employees, representatives, assigns, affiliated organizations, insurers, and all others acting on STAT’s behalf and the owner(s)of any horse or other property used by STAT, from all claims, demands, causes of action, and legal liability, whether the same be known or unknown, anticipated or unanticipated, even if due to negligence and/or other Clients' acts or omissions. Client does further agree to waive all rights which may otherwise arise from an injury to Client or Client's property, and shall not bring any claims, demands, legal actions or causes of action, against STAT, those persons described above, or any person or entity, for any economic or non-economic losses due to bodily injury, death, or property damage arising out of the activities of STAT or Client's presence on or proximity to property used by STAT.

3. INDEMNITY.

Client agrees to be responsible for any and all damages, injuries, or loss of life caused by Client or a horse in the care, custody and control of Client, and to indemnify STAT and all parties described above, for any losses or expenses (including attorney fees) which they incur in connection with claims related to Client.

4. RISKS.

There are numerous obvious and non-obvious inherent risks are always present in horseback riding and being around horses, despite all safety precautions. No horse is a completely safe horse. Horses are 5 to 15 times larger, 20 to 40 times more powerful and 3 to 4 times faster than a human. If a Client falls from a horse to the ground it will generally be at a distance of 3 to 5 feet, and the impact may result in injury to the Client. If a horse is frightened or provoked it may divert from its training and act according to its natural instincts which may include, but are not limited to: stopping short, changing direction or speed at will, shifting its weight from side to side, bucking, rearing, biting, kicking or running from danger. These risks exist for any person around a horse, whether mounted or on the ground. Client acknowledges these risks and states that she/he is not relying on STAT to advise of all the risks.

5. ACKNOWLEDGEMENT AND ASSUMPTION OF RISKS

Client acknowledges that she/he bears responsibility for her/his own safety and Client should not participate in any Client activity unless she/he is confident that she/he can do so safely. Participation in equine activities with or conducted by STAT constitutes a knowing and voluntary assumption of all risks associated with equine activities involving STAT or being present on or using STAT property (including but not limited to inherent risks and the risk of negligence by STAT or others) which is a defense under Pennsylvania law to any claim for injury or damage, and a bar to recovery.

6. HELMET USE.

Client acknowledges that wearing a properly fitted and secured Client riding helmet which meets or exceeds the quality standards of the SEI Certified ASTM Standard F1163 while riding, mounting, dismounting and being near horses may reduce the severity of head injuries or prevent death occurring as the result of a fall or other occurrence. STAT makes no representations as to the condition, effectiveness or suitability of any helmet it may allow Client to use. All helmet related risks are assumed by Client. STAT makes a rule that activities (mounted or unmounted) that an SEI Certified helmet be worn by anyone under the age of 18 years. For unmounted activities, 18 and under require a waiver signed by his/her legal guardian; and any adult can waive helmets for unmounted activities. However, all Clients are required to wear a helmet during mounted activities at STAT.

7. VISITORS.

Should Client bring to STAT any person who is not a party to an Equine Activity Liability Agreement with STAT, Client agrees to have this Liability Form signed prior to arrival at STAT. Client further agrees to educate them as to the risks of being around horses and horse operations, supervise them, be solely responsible for their safety, and to be financially responsible for any injury or loss caused by or suffered by any such person, horses, and STAT property.

8. SAFETY RULES.

Client agrees to follow such rules for safety as are attached or are subsequently provided to them. These are also posted as “STABLE RULES” at STAT property. Client acknowledges that failure to follow STAT safety rules or the directions of STAT’s staff may put her/him at risk of, or increase the risk of, personal injury.

9. SECURITY CAMERAS.

Client acknowledges, understands, and consents to security camera visual recordings operating 24/7 in public areas, such as the entrance, stable, barn, and perimeter areas. Only authorized STAT clinical staff have access to such recordings and footage is continually recorded over, therefore never retained indefinitely.

10. PREMISES INSPECTION.

Client has inspected the farm's premises and facilities and/or have in some other way satisfied himself/herself that the condition of the premises and the facilities will provide an adequate and reasonable level of safety for Client and any guests, or visitors they bring on the premises.

11. OTHER TERMS.

This document states the entire agreement between the parties as to liability and may not be changed, except in writing signed by the parties. The benefits of this agreement, including the release of legal liability, waiver of rights, indemnity and covenant not to sue, are intended to benefit others, including STAT’s officers, directors, shareholders, members, managers, agents, employees, representatives, assigns, affiliated organizations, insurers, and all others acting on STAT’s behalf and the owner(s) of any horse or other property used by STAT. This agreement shall be binding upon STAT, Client, and Client's heirs or estate, when signed by the parties. If any clause, phrase or work is in conflict with State Law then that single part is null and void. This agreement and acknowledgments shall remain in force until terminated by Client through written notice to STAT at the address above. The General Court of Justice Westmoreland County, Pennsylvania shall be the exclusive venue for any litigation between Client and the parties described above.

12. PHOTOGRAPHY/MEDIA RELEASE

Adult clients and parents wishing to take pictures of their child/children during a riding lesson will require advanced approval from STAT CEO, which is discussed and agreed upon beforehand.

ACT 93 of 2005 Equine Activity Immunity Act.

WARNING: Under Pennsylvania Law an equine activity sponsor or an equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities.

Privacy of STAT Clients Receiving Services & Social Media:

We do our best to respect and maintain every STAT client's privacy. We uphold confidentiality of those receiving medical and EAL/EAT/EAP services and also safeguard clients' information by using Theranest, a HIPAA compliant electronic record keeping program. As such, we have professional boundaries and a global privacy policy not to engage in conversations on STAT's Facebook & social media with STAT Clients. You are welcome to post messages but we want you to understand we may reply with a "heart" not with a conversation.

We value all of our STAT's clients and hope you understand our policy. If you need to speak with us, please give us a call. Please do not engage us personally on social media (Facebook, LinkedIn, Twitter, Snapchat, Instagram, etc.). Additionally, for your privacy, we will not approach you outside of class. If you choose to approach us, we cannot guarantee your privacy.

Please complete Information below acknowledging you attest to and have read, understood, and agree to entire application and then click "submit" at the bottom of the application:

This application is received by the STAT INC CEO and responses remain confidential. A staff member will be in touch. If you have questions, please feel free to contact STAT at 607-223-4176 or via email at cmarkosky@statinc.org. By submitting this form you give STAT staff permission to call you to briefly discuss the information on the form.