Participant Program Registration Form
Welcome to SPIRIT Open Equestrain Program. Before you continue, please find out more about our policies and procedures to keep us all safe during the CORONA 19 pandemic episode

Precautions for a reopening SPIRIT
Paticipants, Volunteers, Staff
SPIRIT will adhere to federal, state, county and FCPS regulations or guidelines.
Centers for Disease Control (CDC) guidelines:
• Shelter-in-place/quarantine mandates/guidelines
• Wearing of facial masks
• Maintaining social distancing guidelines
• Following gathering size guidelines
These regulations or guidelines can be found on Protect Yourself & Slow the Spread of COVID-19 | Health
Consideration for Therapeutic Riding Program Participants
A disability alone may not be related to higher risk for getting COVID-19 or having severe illness. Most people with disabilities are not inherently at higher risk for becoming infected with or having severe illness from COVID-19. However, some people with disabilities might be at a higher risk of infection or severe illness because of underlying medical conditions. All people seem to be at higher risk of severe illness from COVID-19 if they have serious underlying chronic medical conditions. Adults with disabilities are three times more likely than adults without disabilities to have heart disease, stroke, diabetes or cancer.
Link for high risk conditions: https://www.cdc.gov/coronavirus/2019-ncov/hcp/underlying-conditions.html Link for information from CDC on disabilities and COVID-19: https://www.cdc.gov/coronavirus/2019-ncov/need-extra- precautions/people-with-disabilities.html

We have prepared our work areas according to the CDC recommendations by reducing transmission among employees, maintaining healthy business operations and maintaining a healthy work environment.
• Anyone coming onto the property who is sick or has someone in the household who is sick should stay home or reschedule. This includes employees, volunteers, participants and their caregivers.
• SPIRIT encourages frequent hand washing; at the hand wash station in the barn, or at Park restrooms. If soap and water are not readily available, we shall provide alcohol or bleach-based spray sanitizer for all students, volunteers, staff members
• Posters that encourage hand hygiene to help stop the spread will be placed at the entrance to our gathering areas
• Handshaking, hugs are not acceptable, we encourage the use of other non contact methods of greeting.
• Routine environmental cleaning and disinfection:
o Routinely cleaning and disinfecting all frequently touched surfaces, such as workstations, keyboards, telephones, handrails, doorknobs, stall doors, tack and other commonly used equipment.
o If surfaces are dirty, they should be cleaned using a detergent or soap and water if available or disinfectant spray
o Discouraging all from using other’s’ phones, desks, offices, or other work tools and
equipment, when possible. If necessary, clean and disinfect them before and after use.
o Providing disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks, other work tools and equipment)should be wiped down by staff/volunteers before each use.

* General rules of social interaction during the pandemic issued by public health authorities, local, state and federal government and Fairfax County Park Authority are automatically mandatory rules at SPIRIT
* All enclosed areas at SPIRIT Farm Operational site (Feed room, Tackroom, Office, stalls) have one person limit until further decisions
* size of the class or group will be limited according actual recommendation
* a physical distance of 6 or more ft, is mandatory while working in the barn area or in the program, except lessons with riders who require full "hands on support".
* face covering and gloves are mandatory for any group activity when distance is less than 20 ft
* if student/volunteer/staff or anyone in their household do not feel well, have a fever or other symptoms of COVID 19 infection, should not come on site and and it is mandatory to notify SPIRIT Office about it
*Instructor, therapist, assistant or assigned volunteer will keep track of any personal contact, as well as attendance of program activities, and make it available to authorities for tracking purpose
* Instructor, therapist, assistant or assigned volunteer will organize and supervise prior, between and after classes- disinfection of gates, doors, restroom, feed room, tackroom, office and all items used for activities (helmets, vests, grooming kits, toys), and control temperature of all attendees using no contact thermometer
* hands of all on site should be washed/wiped/sprayed at least before, in between and after each class, and staff/senior volunteers will supervise and encourage that policy
* mounting procedure should be done with not more than 3 people (Instructor, horse manager, one side walker)
* students who require "hands on" support will have one volunteer provided by family from the own household
*SPIRIT will provide training for parent/caregiver/sibling (over 14 years old) to safe support student who needs full support during the session

SPIRIT encourages everyone on site to provide their own PPE when on site, but will have some rady for essential volunteers/staff/visitors/students as needed.

• Communication with the participant, parent or caregiver prior to a session to:
o Verify that there are no underlying health issues that would go against any shelter-in-place mandates.
o Ask if the participant or anyone within their household do not have symptoms present, such as a fever or cough.
o Explain how the center is monitoring the health of the staff.
o Explain how the center is cleaning AND disinfecting equipment and common areas.
o Explain what they can expect when they arrive, such as hand washing expectations or wearing of masks.
o Explain how social distancing is going to work within the session or what alternative activities are
available.

I fully understand and agree to follow these and any future policies and procedures during a program activity




Participant's Full Name *
Address *
Home Phone
Cell Phone
E-mail *
Date of Birth *
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Weight *
Height *
If participant is a minor, parent/guardian name and address, if different from above
Participant's or parent's work place/employer *
Registration For: *
Let us know anything you feel it might be important for us to deliver safe and beneficial service to you and your family *
Please, let us know your goals and expectations *
For Equine Assisted Psychotherapy, Therapeutic Riding and Therapeutic Horsemanship participants - Please let us know about personal goals and diagnoses or condition(s) indicated for Equine Assisted Therapies or Therapeutic Activities (consult your physician/therapist as needed) *
Authorization for Emergency Medical Treatment - In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on the property of the agency, I authorize Spirit OEP to: 1. Secure and retain medical treatment and transportation if needed. 2. Release client records upon request to the authorized individual or agency involved in the medical emergency treatment. *
Consent Plan - I do give my consent for emergency medical treatment/aid in the case of illness or injury during the process of receiving services or while being on the property of the agency. This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed "lifesaving" by the physician. This provision will only be invoked if the emergency contact is unable to be reached. *
Non-Consent Plan - I do not give my consent for emergency medical treatment/aid in the case of illness or injury during the process of receiving services or while being on the property of the agency.
Clear selection
In the event of an emergency, contact (name, phone #, email) *
I hereby grant Spirit Open Equestrian Program permission to interview me/my child and/or to use my likeness in photographs/videos in any and all of its publications and in any and all other media, whether now known or hereafter existing. I will make no monetary or other claim against Spirit OEP or its staff for the use of the interview and or the photographs/videos. This is a total release in perpetuity to any right, title or interest. *
Clear selection
Would you like to stay in touch by e-mail to hear about other SPIRIT activities and programs? (you can always select 'no' later) *
Date *
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Participant's or Parent's (if participant is a minor) electronic signature, as proof that all above is accurate. By typing your name here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request to sign a paper copy instead. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. If you need to change any information in this document, please contact spiritoep@spiritequestrian.org *
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