Equine Assisted-Counseling Application - (8/2023)

TROT Policies
Before completing this application, please open and read TROT's updated policy and procedure guide. By submitting this application, you acknowledge and agree to TROT's Terms and Conditions within the updated Policy and Procedure Guide.
Applicant Information

Personal Health Information

Personal Goals

Contact Information

Medical Emergency Contact Information
In the event of a medical emergency, TROT will provide basic first aid and/or call 911 and will disclose all available health care information to emergency medical personnel.

Participant Liability, Confidentiality Agreement, Photo and Video Release
Liability Release: I acknowledge that risks and potential risks for horseback riding and activities in and around a facility where horses are kept, and farm machinery operated. However, I feel that the possible benefits to me/child/my ward are greater than the risk assumed. Intending legally to bind myself, my heirs, and assigns, executors or administrators, I hearby waive and release forever all claims for loss or damages of any kind against TROT, its Board of Directors, Instructors, Therapists, Aids, Volunteers and Employees for all and all injuries and losses that I/my child/ my ward may sustain while participating in the TROT program. This release includes without limitation to the risk of negligent instruction and supervision. I engage in activities at TROT voluntarily with knowledge of the risks and I assume all risks of injury, death, and property damage that may result. I agree to bear any loss myself. I acknowledge that TROT and the property owners are materially relying on this waiver and assumption of risk allowing me/my child/my ward to participate in activities at TROT.

Confidentiality Agreement: I understand that all the personal information (written and verbal) about participants at TROT is confidential and not to be shared with anyone without expressed written consent of the participant of their parent/guardian if a minor. 

Photo and Video Release: The use and reproduction by TROT of any audio/visual materials taken of me/my child/my ward for distribution to the public for promotional printed materials, educational activities or for any other use for the benefit of the program.