New Rider Application

Positive Strides Therapeutic Riding Center, Inc.  ·  P.O. Box 391, Easton, MD 21601

Rider's Registration Form

Fields marked * are required.

Rider Information

Rider's full name is required.
/ /
Date of birth is required (MM/DD/YYYY).
Street address is required.
City is required.
State is required.
ZIP is required.
Phone number is required.
Email address is required.

If you are a school official or caregiver completing this form, please enter your own contact phone and email above, then complete the Primary Contact section below with the parent/guardian information.

Parent / Guardian / Caregiver

Add a Primary Contact (required) and optionally a Secondary Contact — e.g. both a parent and a caregiver.

Primary Contact *
Please select a relationship.
Primary contact name is required.
Secondary Contact (optional)

School / Institution

Prior EAAT Experience

Has the rider ever participated in Equine Assisted Activities and Therapies (EAAT) in the past?
Has the rider ever been convicted of a crime against another person? *
Please answer this question.

Answering yes will not prevent participation — it helps us with scheduling placement.

Demographics (grant/funding tracking only)

Is any family member former/active military?

Diagnoses & Additional Information

Physician Documentation Required
A completed physician form must be submitted before your rider's first session.
⬇ Download Required Physician Docs

Include likes/dislikes, interests, triggers, and anything that helps our staff and volunteers better serve your rider.

Please provide the rider's diagnoses and relevant information.

Equipment

Form Completed By

Please indicate who is completing this form.
Electronic signature — type your full legal name
Signature is required — type your full legal name.
Date is required.
Printed name is required.

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 on the property of Positive Strides Therapeutic Riding Center, Inc.

Rider and contact information is auto-filled from your Registration. Please verify and correct if needed.
Required.
Required.
Required.

Emergency Contacts

To be contacted if the rider cannot legally or physically speak for themselves.

Required.
Required.

Physician & Insurance

Physician's name is required.
Physician's phone is required.

Consent Plan *

Please select a consent plan.
In the event emergency treatment/aid is required, I wish the following procedures (for which I take full responsibility) to take place:

Authorization Statement

I authorize Positive Strides Therapeutic Riding Center, Inc. to:

  • Secure and retain medical treatment and transportation if needed.
  • Release client records upon request to the authorized individual or agency involved in the medical emergency treatment.

This authorization includes x-ray, surgery, hospitalization and any treatment procedure deemed "life saving" by the physician. This provision will not only be involved if the contact person cannot be reached and/or the rider is unable, legally or physically, to speak for herself/himself.

Electronic signature — type your full legal name
Signature is required.
Required.
Required.
Required.

Photo Release

I hereby consent to and authorize the use and reproduction by Positive Strides Therapeutic Riding Center, Inc. of any and all photographs and any other audiovisual materials taken of me/my child/my ward for promotional printed materials, educational activities, social media, Positive Strides website, or for any other use for the benefit of the program.
Please make a selection.
Electronic signature — type your full legal name
Signature is required.
Required.
Required.

⚠ Waiver of Liability, Assumption of Risks & Indemnification Agreement

READ THIS ENTIRE AGREEMENT CAREFULLY BEFORE SIGNING.

Positive Strides, Inc. · P.O. Box 391, Easton, MD 21601 · Revised 8/2/2025

Waiver of Liability

For the privilege of riding, handling, volunteering, working, and/or being around equines at Positive Strides, Inc. on the property owned by Kimberly Hopkins Thomas, Ashley Hopkins and Patricia McQuay (hereinafter "Property Owners") today and on all future dates, I, on behalf of myself, my family members, my heirs, personal representatives, or assigns, do hereby agree to release, waive, and discharge Positive Strides, Inc. and its directors, managers, employees, volunteers, and agents from any liability or responsibility for accident, damage, injury, or illnesses (including bacterial or viral, known or unknown at the time of this signing) to myself or any horse owned or leased by me, or to any family member or spectator accompanying me while on the premises of the property resulting from the inherent risks of equine activities or from the ordinary negligence (active or passive) of Positive Strides, Inc.

AND that except in the event of Positive Strides, Inc.'s or Property Owners' gross and/or willful negligence, I agree not to bring any claims, demands, actions and causes of action, and/or litigation, against Positive Strides, Inc. or Property Owners for any economic and noneconomic losses due to bodily injury, illnesses (viral or bacterial), death, and/or property damage sustained by me in relation to the premises and operations of Positive Strides, Inc.

Assumption of Inherent Risks

I understand and assume the inherent risks involved in equine activities, including those used for therapeutic purposes. These include but are not limited to:

  • The propensity of any equine to behave in ways that may result in injury, harm, or death to persons on or around them
  • The unpredictability of an equine's reaction to sounds, sudden movements, and unfamiliar objects, persons or other animals
  • Certain hazards such as surface and subsurface objects; collisions with other equines, animals, people and objects
  • Limited availability of emergency medical care
  • The potential of a participant or spectator to act in a negligent manner that may contribute to injury

Indemnification

I also agree to hold harmless, defend, and indemnify Positive Strides, Inc. and Property Owners (including costs associated with defending a suit, judgment, court costs, investigation costs, and reasonable attorney fees) from any and all claims arising from my injury, illness, or loss due to my participation as a rider, handler, or spectator.

Health Status & Emergency Care

I assert that I have fully disclosed any chronic conditions and have provided a doctor's release permitting my participation (if applicable). I authorize Positive Strides, Inc. to administer emergency first aid, CPR, use an AED, secure emergency medical care or transportation, and share my medical history with emergency medical personnel when deemed necessary. I shall assume all costs of emergency medical care and transportation provided on my behalf.

Rules & Safety Equipment

I agree to abide by all rules established by Positive Strides, Inc.; to wear an ASTM/SEI certified riding helmet at all times while mounted; and appropriate footwear at all times on the premises.

Covenant Not to Sue; Mediation; Venue

I covenant not to sue Positive Strides, Inc. or Property Owners for any present or future claim arising from my participation with equines. This Agreement shall be construed under the laws of the State of Maryland. Any action must be brought within one (1) year of the incident. Prior to litigation, the matter shall first be mediated equally at shared cost. In the event of litigation, all parties waive trial by jury. Facsimile and electronic signatures shall be accepted as an original signature.

You must acknowledge that you have read and understood the agreement.
Electronic signature — type your full legal name
Signature is required.
Required.
Required.
Required.

Parent / Legal Guardian Signature

If the participant is a minor (under 18) or legally vulnerable person, the parent/guardian signature below waives both the minor's rights and the parent/guardian's rights pursuant to this Agreement.

Electronic signature — type your full legal name

Witness

Electronic signature — type your full legal name

⚠ Farm Waiver

READ THIS AGREEMENT CAREFULLY BEFORE SIGNING.

Timber Grove Farm · 6292 Statum Road, Preston, Maryland 21655

This waiver declares that Ashley Hopkins and Kimberly Hopkins nor anyone associated with Ashley Hopkins, Kimberly Hopkins or Timber Grove Farm is not liable for any injury or accident that may occur while participating in riding or driving lessons, working around farm animals or visiting the premises.

I UNDERSTAND that I am voluntarily participating / or allowing my minor child to participate in a sport that is considered dangerous and can result in serious injury. I realize that when riding or driving, a predator (man) attempts to dominate and control an animal of prey (horse/pony) that is normally ten times larger, stronger and faster.

I UNDERSTAND that the nature of stable horses is unpredictable. The horse/pony can shy, rear, buck, and attempt to throw a rider or driver without warning. No horse/pony is considered completely safe and can cause injury or accident at any time.

I UNDERSTAND that I will adhere strictly to guidelines set forth by Ashley Hopkins and Kimberly Hopkins, and that adhering to those guidelines does not ensure my safety or the safety of those with me.

I UNDERSTAND that Ashley Hopkins and Kimberly Hopkins nor anyone associated with the riding facility is NOT liable for any accident or injury to me, my minor child, or any siblings or guests that may accompany me to the premises. I enter into this agreement and participate at MY OWN RISK and will not attempt to sue Ashley Hopkins, Kimberly Hopkins nor anyone associated with them.

You must acknowledge that you have read and understood the farm waiver.

⚠ Please correct the following before submitting:

    Farm Liability Signature

    Electronic signature — type your full legal name
    Signature is required.
    Required.
    Required.

    For Minor Child – Parent/Guardian Signature

    Complete this section if signing on behalf of a minor child.

    Electronic signature — type your full legal name