Client Registration Form

Thank you for your interest in Forward Stride! Please use this form to register for one of our programs, including single occurrence special visits including girl scouts, clinics, PATH Certifications etc.

Our programs are open to individuals of all levels and abilities. Hippotherapy is a clinical service provided by licensed physical, occupational therapists and speech pathologists. The Riding program includes beginning riding, dressage, jumping, and western. The Veterans program is by referral from the VA or other Veterans Services.

Upon registration for any program, you will be contacted within one week (via email for the Riding or Veterans Program or phone for the Hippotherapy) by one of our Program Coordinators to schedule an evaluation.  After the evaluation, appropriate openings or the lack thereof will be communicated to you within 10 days.  If there is not an appropriate opening, you will be placed on our waiting list and will be contacted when there is an opening or when the next quarter enrollment begins.

Riding lessons are offered in 4 quarterly sessions; Spring, Summer, Fall and Winter.  Each quarter is between 9 and 13 weeks long.  Billing is done by the quarter.  Due to high client volume, registering for the Riding program does not guarantee placement in the current quarter.

The Physician's Release form is required for riders (other than hippotherapy clients) who have physical  diagnoses, including but not limited to Down's syndrome, multiple sclerosis, cerebral palsy, neurological issues, scoliosis, quad- and paraplegia, spina bifida, traumatic brain injury, and bone or joint issues.

Upon registration for any program, you will be contacted within one week (via phone) by one of our Program Coordinators to schedule an evaluation.  After the evaluation, you will be contacted within 10 days regarding scheduling regular sessions.  If there is not an appropriate opening, you will be placed on our waiting list and will be contacted when there is an opening.

Our Hippotherapy program is a fee for service clinical session using the horse as a treatment tool. Payment is expected at time of service from the patient and documentation for insurance reimbursement is provided. We do not bill insurance directly.

To register for the Hippotherapy program, four PDF documents are required. Please use the links below to browse to the documents, print them out, complete them, and then send them to us:

By registering as a Visitor to our facility, you are agreeing to follow all of our rules and to be present at our facility only in the presence of a volunteer, staff member or horse owner. You are not allowed to visit our facility alone. There will be no follow up to this form unless we have specific questions to ask you.

Client Information
Please enter in ft-in format (example: 5-8), without any quotation marks.
lbs
Medical History
Please be aware that we have stinging insects (e.g. bees and wasps) and heavy dust in the area (enter none if no allergies).

Multi-Media Release:
Opportunities sometimes arise for Forward Stride to spotlight participants in our marketing publications.  In addition, Forward Stride is sometimes contacted by the media to do feature stories about specific programs, classes or activities.  When these opportunities occur, the publications may include images (scanned photograph, digital photograph, video) or information regarding the participant's participation in the program or activity being spotlighted.  I agree that images of me or of my minor participant, may be used for promotional purposes, educational purposes, exhibitions or for any other use for the benefit of Forward Stride.

Medical Records Release:
I hereby authorize Forward Stride to release information from my records, or my minor participant's records, to healthcare providers for the purpose of developing an equine therapy or activity program.  The information to be released includes: Medical History; Physical, Occupational or Speech Therapy evaluation, assessment and program plan; Mental Health diagnosis and treatment plan; Individual Habilitation Plan (IHP); Classroom Individual Education Plan (IEP); Psychosocial evaluation, assessment and program plan; Cognitive-Behavioral Management Plan

Medical Emergency Release:
In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on Forward Stride property, I authorize Forward Stride to secure and retain medical treatment and transportation, if needed, for me or my minor participant.  I further authorize Forward Stride to release my, or my minor participant's, information records upon request to the authorized individual or agency involved in the medical emergency treatment.  This authorization includes x-ray and imaging, surgery, hospitalization, medication and any treatment procedure deemed "life saving" by the physician.  This provision will only be invoked if the emergency contact person(s) above is unable to be reached.

Liability Release:
I/My son/daughter/ward/horse would like to participate in Forward Stride programs.  I acknowledge the many and serious risks and potential risks associated with horse activities.  However, I feel that the possible benefits to myself/my son/my daughter/my ward/my horse and the clients are greater than the risks assumed.  As a condition of participation, I hereby, intending to be legally bound, for myself/my son/my daughter/my ward, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Forward Stride, their Directors, Officers, Instructors, Therapists, Aides, Volunteers, horse owners and/or Employees for any and all injuries and/or losses I/my son/my daughter/my ward/my horse may sustain while participating in Forward Stride activities, except for injuries or losses caused intentionally or by willful or wanton disregard for safety.

I hereby agree to the policies, releases, and permissions listed above and I certify that the information contained herein is correct.