Complete Application

Equine Therapy Application

Complete this form to apply for our equine-assisted therapy programs. All fields are required unless marked optional.

Program Interest

Tell us which program you're interested in

Personal Information

Your contact and demographic information

Required for grant reporting purposes

Financial & Grant Qualification

Help us determine your eligibility for grant-funded sessions

Emergency & Medical Information

For your safety during sessions

Include name, relationship, and phone number

Risk Release & Liability Waiver

Required legal document under Utah law

RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND ASSUMPTION OF RISK

In consideration of being permitted to participate in equine-assisted therapy activities provided by Hope Reins Healing ("Provider"), I acknowledge, appreciate, and agree to the following:

ACKNOWLEDGMENT OF RISKS
Pursuant to Utah Code § 78B-4-201 (Equine Activity Liability Limitation Act), I understand that equine activities are inherently dangerous and that participation involves known and unanswered risks that could result in injury, illness, disease, emotional distress, or death to myself and/or my property. I also understand that equines, regardless of training, may act in a dangerous way that may result in injury to the participant.

I understand the inherent risks include but are not limited to:
• The unpredictable nature of horses and their reactions to sounds, sudden movements, and unfamiliar objects
• The potential for a horse to kick, bite, strike, stumble, or fall
• The possibility of equipment malfunction or failure
• Weather conditions and natural terrain hazards
• Physical exertion and emotional responses during therapy sessions

ASSUMPTION OF RISK
I knowingly and voluntarily assume all risks, both known and unknown, associated with equine-assisted therapy activities, even if arising from the negligence of those released below.

RELEASE AND WAIVER
I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release, waive, discharge, and covenant not to sue Hope Reins Healing, its officers, directors, employees, agents, volunteers, sponsors, and any other participants for any liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by me while participating in equine-assisted therapy activities.

This release is governed by the laws of the State of Utah.

Important: Please Read Carefully

This is a legally binding document pursuant to Utah Code § 78B-4-201 (Equine Activity Liability Limitation Act). By signing below, you acknowledge that you have read, understand, and agree to the terms above.

I acknowledge the inherent risks of equine activities under Utah law.

Allow use in promotional materials

Authorize emergency medical treatment

Sign by typing your full legal nameDate: May 1, 2026

Safety Contract & Program Agreement

Your commitment to program safety

SAFETY CONTRACT & PROGRAM AGREEMENT

As a participant in Hope Reins Healing equine-assisted therapy programs, I agree to:

1. SAFETY RULES COMPLIANCE
I will follow all safety rules and guidelines provided by Hope Reins Healing staff at all times. I understand that horses are large animals capable of causing serious injury, and I will conduct myself accordingly.

2. SUPERVISION REQUIREMENTS
I will only interact with horses when a staff member is present and giving direct supervision. I will not enter horse areas, paddocks, or stalls without explicit staff permission.

3. APPROPRIATE CONDUCT
I will treat all horses, staff, volunteers, and other participants with respect. I will not engage in any behavior that could startle or endanger the horses or other participants.

4. DISCLOSURE OBLIGATIONS
I agree to immediately inform staff of any changes to my physical or mental health status that may affect my ability to participate safely. I will disclose any medications, fears, or concerns that may impact my session.

5. PROGRAM PARTICIPATION
I understand that failure to comply with safety rules may result in temporary or permanent dismissal from the program. I acknowledge that all program decisions are made in the best interest of participant and animal safety.

6. CONFIDENTIALITY
I agree to maintain confidentiality regarding other participants' personal information and therapy experiences shared during group sessions.

Key Safety Rules

  • Always approach horses calmly and quietly, never from behind
  • Never run, yell, or make sudden movements around horses
  • Wear closed-toe shoes and appropriate clothing at all times
  • Follow all instructions from staff and facilitators
  • Only interact with horses when a staff member is present
  • Report any unsafe conditions or behavior immediately
  • Keep food and drinks away from horse areas
  • Respect personal space of both horses and other participants

I will follow all safety rules and guidelines provided by staff at all times.

I will only interact with horses under direct staff supervision.

I will immediately inform staff of any changes to my health status.

Sign by typing your full legal nameDate: May 1, 2026

Support Our Mission (Optional)

Help us provide equine therapy to those who need it most

100% of donations go toward providing therapy to those in need

By submitting this form, you agree to the Risk Release & Liability Waiver and Safety Contract terms outlined above.