Pony Prevention
Application to attend Pony Prevention presented by UpRising and CHAPS
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Participant Name *
Parent/Legal Guardian Name *
Email address *
Phone Number *
Participant Date of Birth *
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Participant Grade in School *
Photo Consent/Acknowledgement of Rules
Consent to and authorize the use and reproduction by CHAPS Equine Assisted Therapy/UpRising of any and all photographs and any other audio-visual materials taken of me/my child/my ward for promotional material, educational activities, and exhibitions or for any other use for the benefit of the programs. *
Photo Consent/Non-Consent Signature - I understand that by typing my name below it is the same as using my unique signature. *
Date *
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Rules & Regulations
Dress Code:
1. Footwear: Hard soled shoes or boots with a low heel are preferred for participation. Sneakers may
be used if no boots are available.
2. Long pants: NO shorts, skorts, culottes, carpi pants or dresses/skirts.
3. Shirts: T-shirt or sleeveless shirt is acceptable. No tank tops or short shirts.
4. Jewelry: no jewelry that can get caught in manes or tails (‘dangling’ earrings, necklaces, rings/bracelets,
etc.)
5. Electronic equipment: Cell phones, iPods, Walkman or any other personal electronic devices are not
allowed the riding areas. Participants who arrive with electronic devices will be asked to leave them in the
car or instructor’s office during session. Family members or participant’s guests who are watching the
session must turn off ringers or sounds for any electronic equipment they have on their person.
6. Helmets are available and recommended during activities. However, since this is an unmounted program, participants may opt out of wearing a helmet.

General barn etiquette, procedures and safety rules:
1. No running, screaming or boisterous behavior on the property. Clients must be able to monitor their own
behavior appropriately or have a caregiver with them for supervision
2. Participant’s pets are not allowed at CHAPS, other than service dogs (if service dogs are present, there
must be someone to supervise the dog while the client is working around the horses)
3. Drop off your student in the parking lot (west of the silver shop by the lilac bushes). Please do not park in the parking lot in front of the green house or on the side of the green house, that is rented and is their private parking.
4. Please do not hand feed horses or reach through the bars of the stalls to pet them.
5. Please supervise children at all times when they are not under the direction of their Instructor. Please do
not allow children who are not participating in the session to distract participants with loud or unruly
behavior.
6. All equipment areas and off-limits areas are labeled or located on one of several maps located around CHAPS. Please do not visit the houses or other off limit areas at the facility.
7. No unattended children or dependent adults in the rest room.
8. Participants are not to open stall doors, handle horses or work with a volunteer unless the Instructor is present.
9. Participants are under the direction of their Instructor during the session. Any participant that willfully disobeys an
instructor’s direction may be asked to stop participating in the activity and wait outside the arena for the session to conclude. If you have suggestions for the Instructor, please wait until after the session – your input is very important to the instruction staff but may be distracting during the session.
10. Please feel free to observe a lesson with your child – however, please do not distract them by
speaking to them or attracting their attention once the session has begun, for safety purposes.
11. CHAPS certified Volunteers are provided for session assistance
12. Parents or guardians are welcome to stay and watch. Please note there is NO smoking at anytime on the property. Be prepared for a smoke-free 2.5 hours.
Student agrees to and will adhere to the standards & guidelines provided in this application. Non-compliance may result in my being asked to leave the program. I understand the standards & guidelines are in place for the safety of myself, others and the staff and horses of CHAPS. *
Student Signature - I understand that by typing my name below it is the same as using my unique signature. *
Date *
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Parent/Legal Guardian Signature - I understand that by typing my name below it is the same as using my unique signature. *
Date
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Authorization for Emergency Treatment
Physician's Name *
Participant's Preferred Medical Facility *
Clear selection
In the event that emergency medical aid/treatment is required due to injury or illness during the process of receiving services, or while being on the property of CHAPS, I authorize CHAPS Equine Assisted Therapy staff to secure and retain medical treatment and transportation if needed. *
Parent/Legal Guardian Signature - I understand that by typing my name below it is the same as using my unique signature. *
Date
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General Liability
The undersigned is aware that all activities involving horses including but not limited to riding, driving, grooming, leading or events involving horses pose many inherent dangers, risks and hazards including but not limited to bodily injury and physical harm to rider, groomer, leader, handler, side walker, photographer, spectator and/or helper. I (the undersigned) freely and fully assume all such risks, dangers, and hazards and the possibility of injury, death, property damage or loss resulting from such risks, dangers and hazards. I hereby agree as follows (please initial each line):_______1) To assume and accept all risks, dangers and hazards in connection with my use or my minor child’s orward’s use of the facilities at CHAPS or any off-site activities sponsored by CHAPS_______2) To waive any and all claims that I may have against CHAPS and the property owners as a result of my,my minor child or ward’s use of the facility or participation in any off-site activity sponsored by CHAPS_______3) To release CHAPS, it’s employees, board of director members, volunteers, spectators, clients, property owners and all people involved with CHAPS from any and all liability, rights of action, or causes of action arising out of contract, tort or otherwise for any loss, damage, injury or expense that I, my minor child or ward, next of kin of myself, my minor child or ward, may suffer or incur as a result of use of the facilities or participation in off-site activities sponsored by CHAPS due to any cause whatsoever_______4) The undersigned agrees to hold harmless and indemnify CHAPS, and any employees, volunteers, board of director members, spectators, clients and or property owners from any and all liability for personal injury, property damage or death suffered by myself, my minor child or ward or by a third party as a result of use of and/or presence at the facility or off-site activities sponsored by CHAPS_______5) That, in the event of my, my minor child or ward’s injury or death, this release and indemnity agreement shall be effective and binding upon mine and my minor child or ward’s heirs, next of kin, executors, administrators and assigns in relation to CHAPS, it’s property owners and any and all people involved. *
Parent/Legal Guardian Signature - I understand that by typing my name below it is the same as using my unique signature. *
Date *
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COVID-19 protocols
General: During sessions, minimal physical contact and strict disinfection protocols will be adhered to. All efforts will be made to minimize the number of individuals on property at any given time. Clients and volunteers will be scheduled so as to avoid overlap and prevent extended periods on property. As per the client and volunteer surveys; any individual who has tested positive for COVID – 19, has been in direct contact with an individual who has tested positive for COVID – 19, has travelled outside the State of WY in the last 14 days or has exhibited symptoms of COVID – 19 including but not limited to cough, shortness of breath, fever and chills in the last 14 days will not be allowed on property. All staff will practice social distancing and adhere to CDC guidelines for preventing the spread of the virus to the best of their abilities and as the facility allows (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html).Client screening: A risk assessment worksheet will be completed for all currently enrolled clients. The worksheet will be completed by the Instructor and client (or legal guardian). Upon completion of the risk assessment worksheet, the Executive Director will review the worksheet and approve or deny the client’s participation at CHAPS and the client (or legal guardian) will agree to the potential risks. The approved client will then be provided with a new contract stating the modified trimester dates, an adjusted payment plan, a medical history release stating that they are, to the best of their knowledge, negative for COVID – 19, and a copy of the COVID – 19 Operating Procedures document. A denied client will be required to wait until CHAPS is no longer operating under the COVID – 19 Protocol to resume participation. Should a client be denied full participation at CHAPS they may request a modified lesson plan to minimize or eliminate the potential risk of contracting COVID - 19 posed to CHAPS staff and volunteers. Client Restrictions: Clients will arrive no earlier than ten minutes before their scheduled lesson. They must remain in their vehicle until their Instructor comes to get them. The client will be escorted to and from the arena by the Instructor. The client will be restricted to riding/driving activities only. They will not be allowed to participate in the catching, haltering, grooming, tacking/harnessing, or untacking/unharnessing of their horse. This is to limit the exposure of the horse and equipment to staff only. Only one additional individual will be allowed in the viewing area to support the client. Any other family members, support staff or other will be required to stay in their vehicle at all times. Vehicles will not be kept running as the fumes and loud music/radio are a distraction and danger to the horses and clients. The viewing individual will be escorted to the viewing area by staff and will be asked to disinfect their hands after leaving their vehicle and before exiting the viewing area.2Volunteer Duties: All participating volunteers will be required to fill out the COVID risk assessment before they can participate in any activity at CHAPS. Volunteers will be restricted to only the duties performed in the arena (leading and side walking). While under the COVID -19 Protocol; volunteers will not be allowed to catch, halter, groom, tack/harness or untack/unharness. This is to limit the exposure of the horse and equipment to staff only.1. Volunteers will be asked to wait in their vehicle until ten minutes before the lesson.2. Volunteers will be asked to disinfect their hands upon exiting their vehicle, before coming into contact with the client or horse and equipment (leader/header - lead rope, side walker/ABW - tack/harness).3. Volunteers will enter the Arena from the parking lot thru the gate located at the west end of the Indoor Arena.4. Volunteers will provide aid to the client from the back or side as much as possible. The goal is to avoid standing directly in front of the client as much as possible.5. Volunteers will leave through the gate at the west end of the arena immediately after the Instructor takes control of the lesson horse. Volunteer hours will be tracked electronically and from a remote site, the clip board will not be used. It will be the responsibility of the volunteer coordinators to track when a volunteer comes onto and leaves the property at any given time. Volunteers will be required to wear a mask anytime they are in the arena. All volunteers must watch the video on how to properly wear a mask and it will be noted in their file they have watched it.Instructors:1. Instructors will be responsible for catching, grooming and tacking/harnessing the horse before the lesson.2. Once done, the Instructor will lead the horse into the arena where the volunteer will be waiting.3. The Instructor will escort the client into the arena from the parking lot through the gate located at the west end of the arena after disinfecting the client’s hands (if applicable based on the client).4. Instructors will teach and provide aid to the client from the back or side as much as possible. The goal is to avoid standing directly in front of the client as much as possible.5. After the completion of the lesson the Instructor will escort the client back to their vehicle through the gate at the west end of the arena.6. The Instructor will return to the arena to take control of the lesson horse from the volunteer and return to the barn for untacking/unharnessing, brush down and turn out. All tack and grooming supplies will be moved to the back of the barn by the garden (during good weather) or into Stall #3 (during poor weather) where it will be disinfected and returned to the tack room at the end of the day. No grooming tools or tack will be used consecutively without first being disinfected (reins, helmets, driving gloves, etc.). No lesson horse will be used in two lessons back to back, they must be allowed time for turnout (UV disinfection). Masks must be worn by all volunteers and clients. Staff will wear them except when teaching in excess of 6 feet away.3Instructors will need to disinfect with hand sanitizer between each lesson. Instructors should use hand sanitizer:• Before pulling out tack and grooming supplies• Before catching the lesson horse• After handing off the lesson horse to the volunteer and before coming into contact with the client• After escorting the client to their vehicle and before taking back control of the lesson horse from the volunteer• After turning the horse out• After moving tack to the designated disinfection areaTack: All grooming tools, tack, helmets, driving gloves and halters/lead ropes will be disinfected at the end of each lesson day.• A disinfectant spray can be used on saddle pads, driving gloves, helmets, headstalls, halters/lead ropes and cross ties.• Disinfectant wipes can be used on reins, cinches/girths, saddles, bareback pads.• A bleach bath or spray sanitizer can be used for the grooming tools.• Any props or toys used during the lesson will need to be taken to the disinfection area and cleaned before being used in another lesson. Ground poles, cavalettis, ring stands, the bridge, etc. will need to be sprayed down with disinfectant before being put away. Facility: All staff will participate in end of day disinfection of the main barn area• Gates: into barn (west end), into arena (west end), into viewing area• Sliding doors: into arena, west and east end of Indoor arena, west and east ends of main barn• Door into Instructor’s Office, chain pull on both sides of Arena double doors• Groom stall/saddle stall doors, Stall #3 door when being used as disinfection area for tack• Light switches/pulls: Indoor arena, Instructor’s Office, Main barn• Common areas: Cross ties Saddle racks, White table, Writing utensils, Office chairs and counter, refrigerator and microwave handles Broom closet clip Handles on muck forks, muck shovel, brooms Handles on muck carts Sure Hands Lift Sling, winch control, stool, cone These COVID-19 Operating Procedures are subject to change as the situation progresses, and regulations and state orders change. As the Operating Procedures change, CHAPS will provide an updated version of this document to all pertinent individuals. The Port-a-potty is available for everyone. It should be used sparingly and when used, the handles and seat must be wiped down with sanitizer. It will also be cleaned at the end of each day.
Annexes to COVID-19 protocols
Annex A to CHAPS COVID 19 Procedures
June 1st, 2020
As per the Sheridan Public Health Official Debra Haar:
Volunteers and clients will be allowed to catch and groom horses, effective June 8th, 2020. Volunteers and clients may enter through the main barn door. In order to continue practicing safety in regards to public and client health, volunteers will be required to disinfect (hand wash or hand sanitizer); before catching, after grooming and tacking but before entering the arena for the lesson and upon return to the barn after turnout. Clients will be required to disinfect (hand wash or hand sanitizer); after grooming but before entering the arena to mount, and upon completion of grooming after the lesson. During grooming, tacking and mounting, it is strongly recommended that all persons involved (clients, volunteers, instructors, etc.) wear a face mask to stay in compliance with the social distancing guidelines released by the CDC. Face masks will be supplied by CHAPS and are available upon request. In addition, all tack and grooming supplies will be set aside for disinfection at the end of the day as per the COVID – 19 protocol.

Annex B to CHAPS COVID-19 Procedures
September 21, 2020
As per the Sheridan Public Health Official Debra Haar:
Effective September 29th, 2020 any volunteer, client or staff member that tests positive for COVID-19 must quarantine for a minimum of 10 days, and then must be symptom free for a following 48 hours before being allowed to return to the CHAPS facility in any capacity. Anyone who tests positive will be required to have a letter of release from Public Health after completing the quarantine and symptom free periods.
Any volunteer, client or staff member who happens to be in close contact of a positive case, but does not show symptoms or receives a negative COVID-19 test result, will be required to quarantine for a minimum of 14 days with the following 48-hour symptom free period. If during the 14-day period you remain asymptomatic, you may return to the CHAPS facility. If you develop symptoms at any time during the quarantine period or receive a positive COVID-19 test result, you must extend quarantine for an additional 10 days from onset and then remain symptom free for an additional 48 hours before being allowed to return to the CHAPS facility. Should you receive a positive COVID-19 test result during close contact quarantine you will be required to have a letter of release from Public Health after completing the quarantine and symptom free periods.

Annex C to CHAPS COVID – 19 Procedures
March 17th, 2021
As per Governor Mark Gordon, Wyoming has removed the state-wide mask requirement. In addition, all restrictions on outdoor events have been eliminated.
CHAPS staff and volunteers will no longer be required to wear face coverings when in close contact with clients, (i.e. mounting). The CHAPS mask policy remains in place including the requirement for all new and returning clients and volunteers to submit a COVID – 19 risk assessment before being allowed to participate in any CHAPS activity.
Should a client feel that they are at risk they are welcome to request the use of face coverings, CHAPS staff and volunteers will do their utmost to accommodate the request.
Due to the nature of CHAPS activities the facility falls under the outdoor event guidelines, all of which have been eliminated.
Mask Policy
The CHAPS Board of Directors has declared the use of masks to be up to each individual and his/her
comfort level. Due to the nature of lessons, exertion is common and breathing through a mask while
exerted is difficult. The State of Wyoming does not require any organization to require masks at this time.
Therefore, the use of masks at CHAPS is up to each individual.
A COVID-19 liability release MUST be signed by every client/guardian/caregiver, volunteer and staff
member before they participate in activities at CHAPS, effective June 2, 2020. Every client and volunteer
will complete a COVID-19 Risk Assessment to help them determine their comfort level.
By signing below, I ____________________ (parent/legal guardian) on behalf of _________________________ (student), hereby acknowledge that I have received a copy of CHAPS’s COVID-19Operating Procedures. I further acknowledge that while CHAPS is following the measures set forth in its Operating Procedures, due to the contagious nature of COVID-19 and other infectious diseases, CHAPS cannot guarantee that a participant of CHAPS will not be exposed and/or infected and participation in CHAPS’s programs may increase the risk of a participant in contracting COVID-19 or other infectious diseases, which may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected at CHAPS may result from the actions, omissions, or negligence of myself (or my ward/minor child(ren)) and others, including, but not limited to, CHAPS employees, volunteers, program participants and their families. In understanding these risks, I agree to assume all of the foregoing risks and accept sole responsibility for any injury to my ward, or my child(ren) or myself (including, but not limited to, personal injury, disability, and death),illness, damage loss, claim, liability, or expense of any kind, that I or my child(ren), or my ward, may experience or incur in connection with my/my child(ren)’s/my ward’s participation in the CHAPS programs (“Claims”). On my behalf, or on behalf of my child(ren)/ward, I hereby release, and covenant not to sue, discharge, and hold harmless CHAPS, its employees, agents, board of directors, and representative of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of CHAPS, its employees, agents, board of directors, and representatives, whether a COVID-19 or other infection disease infection occurs before, during or after participation in any CHAPS program. Adult: I acknowledge that I have read and understood this release and indemnity. I am at least 18 years of age and am aware that by signing this document, I am affecting legal rights and liabilities of myself, my heirs, next of kin, executors, administrators, and assigns in relation to CHAPS, its employees, agents, board of directors, and representatives. *
Parent/Legal Guardian Signature - I understand that by typing my name below it is the same as using my unique signature. *
Date *
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