Registration: Hope, Hooves & Healing

Have you already completed the enrollment form for Stepping Stones Program? *

If you have not completed the Stepping Stones enrollment form, please do so after completing this registration. If you do not complete the enrollment form, your registration will not be complete. (https://bridgesofhope.my.site.com/steppingstones/s/) If your child has participated in one of our programs, you do not need to complete the enrollment form again.

Your Name *

First

Last

Email *

Do you require transportation assistance from Summerville to attend this program?

Child's Name *

First

Last

Birthdate *

Shirt Size *

Is there anything new that you feel is important for us to know about the child/teen?

Emergency Contact Information

In the event a emergency occurs, we will contact the parent or legal guardian. We ask you provide us with two OTHER contacts, in the event we are unable to reach you.

Emergency Contact #1 Cell Number

Emergency Contact #1 Name & Relationship to Child?

Emergency Contact #2 Cell Number

Emergency Contact #2 Name & Relationship to Child?

Medical Information

Does the child have any medical conditions that we should be aware of?

May the child take Tylenol or Advil if needed?

Does this child take any medications?

Does the Child have any special diet restrictions?

Does the Child have any allergies?

Does the Child have physical activity restrictions?

May we take photos of the participant during the event for media release purposes, such as promotional materials and online content related to the event?

Consent and Responsibility Clause for Therapeutic Riding Four-Part Series

I, the undersigned, hereby acknowledge and agree to the following terms and responsibilities for my child's participation in the Therapeutic Riding Four-Part Series:

By clicking this checkbox, I affirm that my child will be making a dedicated commitment to participate in the Therapeutic Riding Four-Part Series, consisting of four consecutive sessions, which are vital for the overall therapeutic benefits and progress. I understand and accept that my child must be able to attend all three sessions of the Therapeutic Riding Series, as scheduled, without any absences. Any absences may impact the therapeutic progress and continuity of the program. I am responsible for ensuring that my child arrives on time for each session, allowing ample time for preparation and participation. Punctuality is essential for the safety and effectiveness of the therapeutic riding program. I understand that my child's safety and the safety of others are paramount. I will instruct my child to follow all safety guidelines, directions, and rules provided by the therapeutic riding instructors and staff. I will also inform the program staff of any medical conditions, allergies, or special needs that my child may have. I will maintain open and respectful communication with the program organizers and instructors, promptly informing them of any changes in my child's condition or ability to attend a session. I acknowledge that participation in therapeutic riding involves inherent risks, and I accept these risks on behalf of my child. I will not hold the program organizers, instructors, or their associates liable for any injuries or incidents that may occur during the sessions, except in cases of proven negligence. If, for any reason, my child is unable to continue the Four-Part Series, I understand that I must promptly notify the Bridges of Hope staff. I have read, understood, and agreed to the terms and responsibilities outlined in this Consent and Responsibility Clause for the Therapeutic Riding Four-Part Series. I understand that my child's commitment and consistent attendance are essential for the success of the program and their therapeutic experience.

Physician Form Clause for Therapeutic Riding Four-Part Series

I, the undersigned, hereby acknowledge that my child's registration is not complete until this form is turned back into Bridges of Hope staff.

By clicking this checkbox, I acknowledge that a physician form must be filled out and signed by the child/teen's medical provider. The child/teen will not be eligible to participate in the program without this completed form. It is essential to submit the physician form before the start of the program, and registration is considered incomplete without this submission.

Policies & Consent for Participation

Please read over the information below and sign your name electronically if you give consent

I, the undersigned parent (or guardian) of the child named above (hereinafter referred to as “child”), give my consent for the child’s participation in Bridges programming.

EMERGENCY CARE RELEASE: I authorize, that in an emergency situation, Bridges personnel/school staff to call emergency services. In the event that I cannot be reached or be present, I hearby authorize Bridges personnel/school staff to execute any and all documents including any necessary releases in my behalf which might be required by any medical facility to perform any emergency care on account of an accident or illness sustained or incurred by the child while participating in Bridges’ programming. I further agree that in consideration of my child participation in Bridges’ programming, I will hold Bridges for End-of-Life personnel/school staff harmless from any action by me, my child, or family members on account of any injury or damage sustained or suffered by my child while attending Bridges’ programming, and hereby waive any right of legal action against Bridges for End-of-Life.

MANDATORY REPORTING: Bridges’ staff and volunteers will maintain all confidentiality when working with children. However, South Carolina law does require that any of us report suspected cases of abuse or neglect to ensure the safety of our community’s children. A report must happen if a volunteer or staff member has any reason to believe that a child’s physical or mental health has been, or may be, adversely affected by abuse or neglect. By signing below, you acknowledge you have read and agree to all items listed above.

Signature