High Hopes Therapeutic Riding Inc. Training & Education Program 2018-2019

Training & Education Opportunities 2018-2019

as at 07.30.2018

When you are investing in your future Choose High Hopes - an internationally recognized training facility in Old Lyme, Connecticut

High Hopes Training & Ed. & Events Calendar and CEU Planner 2018-2019

October 2018

November 2018

Oct 5 Registration Deadline for November 12-15 PATH Intl. OSWC

Nov. 26 Registration deadline for January Approved Instructor Training Course

Oct 11, Registration Deadline for November 16-19 ESMHL Workshop

November 12-15, 2018 (also offered in June 2019. PATH Intl. On-site workshop & certification: Approved CEUs = 6 DE; 2 CR; 12 CE.

October 13, 2018 (also offered in May 2019): The ABCs of Participant Behavior and Behavior Management Techniques in the TR and EAAT setting: PATH Intl. Approved CEUs = 7 DE Have you achieved this year’s PATH Intl.CEUs?

February 2019 February 2, Registration Deadline for March 16, Managing Challenging Behaviors

Advanced Prep. Workshop: February 4-6, 2019. PATH Intl. Approved CEUs =10 Riding CR; 5 DE; 6 CE Sensory Integration & Autism Workshop: February 9, 2019. PATH Intl.

Approved CEUs = 7 DE Beyond ESMHL: February 16-18, 2019 PATH Intl. Approved CEUs = 2 ESMHL CR; 6 DE; 8 CE

May 2019 May 3, Registration Deadline for June 12-15 OSWC

November 16-19, 2018 (also offered in April 2019) PATH Intl. ESMHL workshop & skills test: PATH Intl. Approved CEUs = 2 ESMHL CR; 6 DE; 12 CE. Please join us at the High Hopes Holiday Market November 11, 2018

March 2019 March 1, Registration Deadline for March 23, Volunteer Management March 1, Registration Deadline for March 25, Therapy Horse Workshop March 6, Registration Deadline for ESMHL April 12-15 Workshop & Cert.

Therapy Horse Workshop: March 25, 2019 PATH Intl. Approved CEUs = 7 CE Managing Challenging Behaviors to Increase Participant Success: March 16, 2019 PATH Intl. Approved CEUs = 7 DE Volunteer Management: March 23-24, 2019.

PATH Intl. CEUs Day one = 7 CE; Day two = 7 Riding CR

June 2019 Please join us at the High Hopes High Hopes June Benefit June 8, 2019 PATH Intl. On-site workshop & certification: June 12-15, 2019 PATH Intl. Approved CEUs = 6 DE; 2 CR; 12 CE.

January 2019 January has lots of deadlines!

Jan 2, Registration Deadline for February Advanced Prep. Workshop Jan 23, Registration Deadline for February 9, Sensory & Autism Workshop Jan 24, Registration Deadline for February 16-18 Beyond ESMHL Workshop PATH Int’l Approved Instructor Training Course January 9, 2019 - April 2019.

High Hopes is one of only four locations in the Unites States offering the Approved Instructor Training Course.

Jan - Feb, 2019, High Hopes Winter Lecture Series. Check online for more info!

April 2019 April 10, Registration Deadline for June 12-15 OSWC PATH Intl. ESMHL workshop & skills test: April 13-16, 2019 PATH Intl.

Approved CEUs = 2 ESMHL CR; 6 DE; 12 CE.

On Demand ____What’s this year’s plan for achieving PATH Intl.CEUs? Have you thought about On Demand training?

PATH Intl. Registered Instructor Certification _PATH Intl. Advanced Instructor Certification

High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371 Contact:

Non-Profit Business, Development & Administrative Workshop PATH Intl.

Approved CEUs = 12 CE

Sarah Carlson, 860.434.1974 x 115 or scarlson@highhopestr.org

PATH Intl. Mentor Training workshop PATH Intl. Approved CEUs = 14 CE

or go online: highhopestr.org

PATH Intl. Mentor Training Workshop

Date:

On Demand

PATH Int’l CEUs 14 CE About: The purpose of this workshop is to increase the professionalism and knowledge within the Therapeutic Riding Industry. This interactive training provides PATH Intl. Certified Instructors with an overview of the role of a mentor within the EAAT industry and the necessary skills and tools to apply this knowledge to mentor other instructor candidates. This workshop includes 12 hours of classroom education and 8 hours of online education, which applies towards annual continuing education hours for compliance as a PATH Intl. Certified Instructor. The objectives of the workshop are to enhance and build observation, evaluation and feedback skills through group activities and to give the mentor tools that will help individual mentors and centers in setting up a mentoring program, including enhancing communication skills and to build a trusting and collegial relationship between the mentor and mentee.

Faculty: High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

Kitty Stalsburg, PATH Intl. Master Instructor, ESMHL and High Hopes Executive Director Patti Coyle, PATH Intl. Advanced Instructor, ESMHL and High Hopes Training & Education Director

Workshop Prerequisites: For Certified Mentor prerequisites and a complete description of the current Mentor Certification process, please consult the PATH Intl. website or call the PATH Intl. office at 800.369.7433 - PATH Intl. member and PATH Intl. Certified Instructor - 18 Years or older - Complete a review of the online CAT course and Self Study, unless you have completed it within the last 12 months. Workshop participants will be enrolled through their registration with the PATH Intl. Center holding the workshop.

Time: Day 1: 10am - 6pm, Day 2: 8am - 3pm Price: $350* (min. number participants needed, inc. light lunch) Course Materials: Will be provided at the workshop To Register: Please complete attached forms and send with your fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org or register online at http://www.highhopestr.org Reg. Deadline: Call for more info. 2 months prior to preferred date Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

PATH Intl. Mentor Training Workshop HIGH HOPES THERAPEUTIC RIDING INC. CONTINUING EDUCATION HIGH HOPES THERAPEUTIC RIDING, Inc. Registration Form Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________

Zip: ________________

Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: ___________________ _____(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following workshop: PATH Intl. Mentor Training Workshop, preferred On-Demand Date______________________ Fee: $350* (inc. light lunch) Registration cost includes: A light lunch For reference only we provide below the key prerequisites as listed at time of print on the PATH website. For current Certified Mentor prerequisites and a complete description of the current Mentor Certification process, please consult the PATH Intl. website or call the PATH Intl. office at 800.369.7433: • Current PATH Intl. member and hold current PATH Intl. Instructor Certification (Registered, Advanced, Master, Driving, Vaulting, etc.)

• Successful completion of a PATH Intl. Mentor Training • Annually signed PATH Intl. Mentor Code of Ethics (to be sent out electronically in January each year) • Attend one PATH Intl. Instructor Workshop/Certification (discipline/level specific) • Access to e-mail for online communication • Signed permission, completed at the end of the mentor workshop, to be advertised on the website.

Cancellation and Refund Policy: High Hopes reserves the right to cancel all or any part of the workshop and/ or certification due to unforeseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations for on demand workshops and/or certifications up to 14 days before the first workshop /certification day, will receive a full refund minus a $150 service fee. No reimbursements will be granted after this. I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨

I consent _

¨ I Do Not Consent

Date:________________________ Consent Signture:___________________________________________ Once registered you are required to complete the PATH Intl. CAT Course and Registered Instructor Self Study. Participation in these courses is included in your registration fee. If you are a PATH Intl. instructor, you are also required to bring a hard copy of the on-line self study and the booklet/criteria for the certification and/or specialty certification in which you hold PATH Intl. Instructor Certification.

Date:________________________ Consent Signture:___________________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

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PATH Intl. Registered Instructor Certification ON DEMAND

Certification Date: On Demand About: High Hopes offers “Certification on Demand” for “first time” participants who are unable to attend our twice-a-year OSWC dates, and for those who need to take the certification a second time (“recertification”). In order to become a PATH Intl. Registered Instructor, you must complete two phases of the certification process.

Faculty Patti Coyle PATH Intl. Advanced Instructor/Lead Evaluator

Megan Ellis PATH Intl. Advanced Instructor/Lead Evaluator Faculty - subject to change

Time: T.B.D. Price: $200 to $500 (please see application form for details) Prerequisites: • Phase Two first time participants

Upon successful completion of Phase One, you will receive a confirmation letter from the PATH Intl. office. At this point you are considered an Instructor-In-Training (IT). You may retain this designation for twelve months from the date of your confirmation letter. At the end of the twelve months, you must have completed all the components of Phase Two:

High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

- Complete 25 hours of teaching mounted therpeutic riding lessons under the supervision/mentorship of a PATH Intl. Certified Instructor.

- Attend a Registered Instructor On-Site Workshop. You must attend a workshop PRIOR to the certification component. (Please note that the workshops are valid for 2 years).

- Successfully complete a Registered Instructor On-Site Certification

• Phase Two recertification participants

• Business management, marketing fundraising, & board development.

- Attend a workshop within two years of the certification and provide proof to the host site

- Complete teaching hours within two years of the certification

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

- Submit an extra 10 hours of mentored teaching for those who did not meet criteria on both components

- Fill out a new Phase Two packet (this can include the same references).

Must include CPR, First Aid, etc.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies:

- Submit the PATH Intl. “resubmission application form” which has the resubmission deadline on it. It is one year from the date the letter was sent. This letter replaces the IT letter

• P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

Registration Deadline: Requested dates must be one month or more from the submission of this application to allow time for processing and scheduling.

To Register: Please complete attached forms and send them together with the

required fee and documents listed to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org

Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

PATH INTL. REGISTERED INSTRUCTOR CERTIFICATION ON DEMAND High Hopes Therapeutic Riding Inc. Registration Form Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________

Zip: ________________

Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: __________________ _(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following:

RIDING ONLY^ - $200

TEACHING ONLY^ - $300

FIRST TIME CERTIFICATION^ - $500

________________ 1st Choice Date ________________ 2nd Choice Date

________________ 1st Choice Date ________________ 2nd Choice Date-

________________ 1st Choice Date ________________ 2nd Choice DateThe

^ You must provide proof of having attended a PATH Intl. Approved On-Site Workshop in the last two years For certification please note that High Hopes Horses have a weight limit of 180lbs. We do require a submission of a riding video prior to confirmation from candidates at or over 165 lbs. Submission of the video is for the center to ensure we can accommodate all candidates during their mounted ride for certification. This video will be reviewed by our center representative and will not be utilized for evaluation. If you exceed this weight limit, you will need to contact PATH Intl. for accommodation requirements of the riding portion of certification.

Cancellation and Refund Policy: High Hopes reserves the right to cancel all or any part of the workshop and/ or certification due to unforeseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations for on demand workshops and/or certifications up to 14 days before the first workshop /certification day, will receive a full refund minus a $150 service fee. No reimbursements will be granted after this. I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org_ ¨ I consent ¨ I Do Not Consent Date:________________________ Consent Signture:___________________________________________

FOR CERTIFICATION Candidates ONLY please check and complete the following: ¨ I am at least 18 years old

¨ I am a current PATH Intl. Member

HEIGHT____________________ WEIGHT_________________________ Preferred riding discipline ¨ English ¨ Western

Date:_______________________________________ Signature: ___________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

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PATH Intl. Advanced Instructor Certification ON DEMAND

Certification Date: On Demand About: In order to become a PATH Intl. Advanced Instructor, you must

successfully complete the Advanced Certification packet (located on the PATH Intl. website) and return it to High Hopes Therapeutic Riding, Inc. with a copy of your PATH Intl. membership card, and current copies of your CPR and First Aid Certification.

Faculty Kitty Stalsburg PATH Intl. Master Instructor/Lead Evaluator Patti Coyle PATH Intl. Advanced Instructor/Evaluator Faculty - subject to change

Time: T.B.D. Price: $250 to $1000 (please see application form for details) Prerequisites: Pre-Requisites for Advanced Certification:

- Candidate is at least 21 years of age - Current PATH Intl. member - Candidate is already a PATH Intl. Registered Instructor or Driving Instructor - Current copy of CPR and First Aid Cards - Documentation of Teaching Hours Form (120 hrs. minimum under supervision of certified PATH Intl. instructor)

High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

Additional Paperwork will be requested with your confirmation letter: - Resume & References (Personal and Center Reference) - Release Forms: Emergency Medical Treatment Form, Liability Release Form and Photo Release Advanced Written Exam: This is the exam candidates must take to complete their certification.

The exam can be taken on-site at the certification however it is recommended to be taken prior to the on-site certification online with a proctor. Contact PATH Intl. for details.

Accomodations: An accommodation is an adjustment or an adaptation of a component

or components of the Advanced Instructor Certification Process in order to meet the special needs of the candidate. Requests for an accommodation to any part of the process must be made in writing and submitted to the PATH Intl. office 60 days prior to your On-Site Certification date. All requests for accommodations will be reviewed by the PATH Intl. Riding Certification Subcommittee on an individual basis and applicants will be notified of the committee’s decision. For more information please contact the PATH Intl. office. For example, if you are over the Host Site’s weight limit and they cannot accommodate out side horses you will need to ask the PATH Intl. office for an accommodation.

Registration Deadline: Requested dates must be two months or more from the submission of this application to allow time for processing and scheduling.

To Register: Please complete attached forms and send them together with the

required fee and documents listed to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org

Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

PATH INTL. ADVANCED INSTRUCTOR CERTIFICATION ON DEMAND High Hopes Therapeutic Riding Inc. Registration Form Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________

Zip: ________________

Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: __________________ _(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following: ADVANCED CERTIFICATION - $1,000 ________________ 1st Choice Date ________________ 2nd Choice Date

ADVANCED RE-CERTIFICATION (check those parts that apply) ________________ 1st Choice Date ________________ 2nd Choice Date

¨ ¨ ¨ ¨ ¨ ¨

$400.00 Riding and Stable Management $600.00 Teaching Cognitive and Physical $350.00 Teaching Cognitive $350.00 Teaching Physical $250.00 Teaching Able Bodied $250.00 Lunging

Dates must be at least 2 months from submission of this form to allow time for processing and scheduling; contact High Hopes for guidance on best time frames for on-demand events. Deadlines for remaining paperwork will be determined once dates have been confirmed. Dates selected for testing must be agreed upon by both parties based on High Hopes calendar and resources available.

For certification please note that High Hopes Horses have a weight limit of 180lbs. We do require a submission of a riding video prior to confirmation from candidates at or over 165 lbs. Submission of the video is for the center to ensure we can accommodate all candidates during their mounted ride for certification. This video will be reviewed by our center representative and will not be utilized for evaluation. If you exceed this weight limit, you will need to contact PATH Intl. for accommodation requirements of the riding portion of certification.

Guidelines for re-certification candidates: Candidates looking to re-test for the Advanced Certification must complete the written exam and demonstrate proof of completion prior to their agreed upon certification date. Candidates seeking onsite testing with proctor must pay an additional fee of $250. Candidates must present a copy of their “Resubmission Application Form” from PATH Intl. demonstrating requirements for re-testing. All additional Advanced Certification Application packet materials must be completed and provided to High Hopes three weeks prior to the agreed upon testing date.

Cancellation and Refund Policy: High Hopes reserves the right to cancel all or any part of the workshop and/ or certification due to unforeseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations for on demand workshops and/or certifications up to 14 days before the first workshop /certification day, will receive a full refund minus a $150 service fee. No reimbursements will be granted after this. I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org_¨ I consent ¨ I Do Not Consent Date:________________________ Consent Signture:___________________________________________

FOR CERTIFICATION Candidates ONLY please check and complete the following: ¨ I am at least 21 years old

¨ I am a current PATH Intl. Member

HEIGHT____________________ WEIGHT_________________________ Preferred riding discipline ¨ English ¨ Western Date:_______________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

INTENTIONALLY BLANK PAGE

Winter Lecture Series at High Hopes

Lectures are designed for the equine professional interested in therapeutic riding, therapeutic riding Instructor-In-Training, and currently Certified Instructor looking for advancement and continuing education hours. Full and half day lectures are open to volunteers and professionals in the field for a nominal fee and are conducted as part of the PATH International Approved Instructor Training Course. Please visit our website at www. highhopestr.org for additional information and pricing on our workshop offerings. We look forward to having you join us for a mid-winter break in our picturesque New England setting.

01/12/19 - Growth and Development & Mounting and Dismounting: Carolyn Jagielski, Physical Therapist, PATH Intl. Registered Instructor. This introductory lecture will discuss human movement analysis as well as biomechanics. PATH Intl CEU’s =5 DE; 2 Riding CR 1/14/19 - Physical Disabilities: Neurological Impairments / Orthopedic Impairments: Carolyn Jagielski, Physical Therapist and PATH Intl. Registered Instructor. This lecture will provide an overview of physical disabilities and teaching considerations. PATH Intl CEU’s= 7 DE 1/15/19 – Speech and Language & Precautions and Contraindications: Franice Ketaineck, SLP, Carolyn Jagielski, Physical Therapist and PATH Intl. Registered Instructor. This lecture includes considerations and techniques for speech and language as it relates to EAAT in addition to an overview of precautions and contraindications. PATH Intl CEU’s= 7 DE

High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

01/16/19 - The Effective Instructor: Kitty Stalsburg, High Hopes Executive Director, PATH Intl. Master Instructor & Sarah Carlson, High Hopes Special Programs Manager, PATH Intl.

Advanced Instructor and Certified Driving Instructor. Techniques of effective instructing will be discussed, including teaching strategies, lesson planning and task analysis, and discussion of PATH Intl. standards and guidelines. PATH Intl CEU’s= 7 Riding CR 01/17/19 & 1/18/19- The Therapy Horse, Parts 1 & 2: Holly Sundmacker, High Hopes Equine Operations Director & Lauren Fitzgerald, High Hopes Equine Resource Manager, PATH Intl. Advanced Instructor and Certified Driving Instructor. These two sessions will cover key aspects of the management of a therapy horse herd, including selection, evaluation, training, handling and general herd management. PATH Intl CEU’s= 6 CE per day 01/22/19 & 01/23/19 - Cognitive and Psychosocial Impairments Parts 1 & 2: Laura Moya, MFT, PATH Intl. Advanced Instructor, Barbara Abrams PHD, LPC, Expressive Therapist, Advanced Instructor. This two day lecture will review cognitive disabilities and discuss teaching considerations, competencies, role playing, games and activities. PATH Intl CEU’s= 7 DE per day 01/24/19 - Facility, Standards and Risk Management (1/2 day): Kitty Stalsburg, High Hopes Executive Director & PATH Intl. Master Instructor. This lecture reviews PATH Intl. standards with an emphasis on risk management & facility needs. 9:00am-1:30pm PATH Intl CEU’s = 4 CE Time: 9:00am - 5:00pm or 9:00am - 1:30pm Price: $45 half or $65 full day, Any 3 lectures $175, any 6 $325 To Register: Please complete attached forms and send them with the fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org or register online at http://www.highhopestr.org Reg. Deadline: December 27, 2018 Course Materials: Any needed will be provided at the workshop Terms:

Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

Winter Lecture Series 2019 HIGH HOPES THERAPEUTIC RIDING INC. CONTINUING EDUCATION HIGH HOPES THERAPEUTIC RIDING, Inc. REGISTRATION FORM Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________

Zip: _____________

Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: ____________________ _(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following winter lectures: ¨ 01/12/19 - Growth and Development & Mounting and Dismounting

¨

01/17/19 The Therapy Horse, Part 1

Office Use Only

¨

01/18/19 The Therapy Horse, Part2

____ Lectures at $45 total

$_____

¨ 1/14/19 Physical Disabilities: Neurological Impairments / Orthopedic Impairments

¨ 01/22/19 Cognitive and Psychosocial Impairments Part 1

_____ Lectures at $65 total

$_____

¨ 1/15/19 Speech and Language & Precautions and Contraindications

¨ 01/23/19 Cognitive and Psychosocial Impairments Part 2

_____ Any 3 Lectures $175

$____

____ Any 6 Lectures $325

$____

01/16/19 The Effective Instructor

¨ 01/24/19 Facility, Standards and Risk Management (1/2 day)

¨

$ =====

Cancellation and Refund Policy: High Hopes reserves the right to cancel the workshop and/or the skills test/certification up to 5 business days after the registration deadline on the front of this flyer due to insufficient registrants or unforseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations prior to the registration deadline will receive a 50% refund. No reimbursements will be granted after the registration deadline. I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨I consent ¨ I Do Not Consent Date:________________________ Consent Signture:___________________________________________

Please describe your interest and experience in therapeutic horsemanship: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

Attn: Sarah Carlson, or register online at http://www.highhopestr.org.

Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary. For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

INTENTIONALLY BLANK PAGE

PATH Intl. Advanced Certification Preparation Workshop

Date:

February 4-6, 2019

PATH Int’l CEUs 10 Riding CR; 5 DE, 6 CE About: This 3-day workshop will focus on providing a comprehensive review of PATH Intl. Advanced Instructor Criteria and will explore all aspects of the criteria through classroom discussion, hands on learning, and teaching opportunities with current High Hopes participants. This workshop will include many opportunities for discussion and candidate evaluation.

Topics :

High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

• Cognitive and Physical disabilities • Able-Bodied teaching • Personal riding skills through participation in a lesson • Group Instruction to individuals with disabilities • Lesson planning for diverse groups • Advanced mounting and dismounting techniques • Lungeing techniques

Faculty:

Liz Adams, PATH Intl. Master Therapeutic Riding Instructor

Who should attend? • •

•

Instructors seeking professional development Those planning to attend an Advanced Certification in the next two years Anyone wishing to hone their teaching skills

Prerequisites: • High Hopes horses have a weight limit of 180lbs • Must be PATH Intl. Registered Instructors with over 75 hours of instruction • Must be secure riders at walk, trot & canter Deadline: Register by January 2, 2019 (max 6 participants) To Register: Please complete attached forms and send with your fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org or register online at http://www.highhopestr.org Time: 8:30am – 5:00pm Price: Workshop Only: $675.00 including light lunch Course Materials: Provided at the workshop Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

PATH INTL. ADVANCED PREP WORKSHOP HIGH HOPES THERAPEUTIC RIDING, Inc. REGISTRATION FORM Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________

Zip: ________________

Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: ___________________ _____(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following workshop: Advanced Prep *Workshop ONLY $675.00 ________ February 4-6, 2019 Registration cost includes: A light breakfast and lunch each day CCancellation and Refund Policy: High Hopes reserves the right to cancel the workshop and/or the skills test/certification up to 5 business days after the registration deadline on the front of this flyer due to insufficient registrants or unforseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations prior to the registration deadline will receive a full refund minus a $150 service fee. No reimbursements will be granted after the registration deadline. I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨ I consent _

¨ I Do Not Consent

Date:________________________ Consent Signture:_____________________________

Please confirm: ¨ I am at least 21 years old ¨ I have at least 75 hours teaching experience HEIGHT_______________________ WEIGHT______________________ Preferred riding discipline ¨ English ¨ Western ¨ I have requested the following accomodation from PATH Intl. __________________________________________________________________________________________ Date:_______________________________________ Signture: ___________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

HORSEMANSHIP & EDUCATIONAL EXPERIENCE FORM Please type or print clearly in ink.

Please include a copy of your actual resume as well. (this information will be shared with your Host Site Representative) THERAPEUTIC RIDING

CONTACT Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________

Zip: ________________

Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Affiliated with the following operating center: ___________________________________________ _(e.g. High Hopes TR, etc.)

Role or position: ________________________________________________ Are you a licensed therapist? PT ¨ OT ¨ Other Therapist _________________________________________ EDUCATION High School_______________________________________ Year:___________________ Diploma______________ College or vocational_______________________________ Year:___________________ Diploma______________ Other Studies/Certificates/License:________________________________________________________________ Work Experience related to disabilities (other than therapeutic riding):___________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ EQUESTRIAN BACKGROUND Number of years riding: _______ _Owning a horse: _____________ _Number of years giving riding instruction:______ Type(s) of instruction:___________________________________________________________________________ 4-H level:___________________ Describe your equine experience:_________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ EXPERIENCE TEACHING RIDERS WITH DISABILITIES (check any and all that apply to your experience) ¨

Impairments

¨

Autism

¨

Spina Bifida

¨

Learning Disabilities

¨

Down Syndrome

¨

Stroke/CVA

¨

Communication impairment

¨

Cerebral Palsy

¨

Post-Polio

¨

Hearing impairment

¨

Multiple Sclerosis

¨

¨

Visual impairment

¨

Muscular Dystrophy

¨

Emotional impairment

¨

Brain Injury/Head Trauma

Other________________________ ________________________________ ________________________________ _________________________________

ADDITIONAL INFORMATION Professional organizations of which you are a member_________________________________________________ ____________________________________________________________________________________________ Articles/Books/Lectures you have done:____________________________________________________________ ____________________________________________________________________________________________

Sensory Integration and Autism Workshop

Date:

February 9, 2019

PATH Intl. CEUs 7 DE About:

Faculty:

This workshop is ideal for all therapeutic riding professionals seeking an interactive, hands-on educational experience to further their understanding of Autism and Sensory Processing Issues in the TR setting.

Leslie Bridges-Parent, Pediatric Occupational Therapist Sarah Carlson, PATH Intl. Advanced Therapeutic Riding Instructor, ESMHL

Who should attend? • PATH Intl. Certified Instructors seeking professional development.

• Educators & EAAT Industry Professionals

• Individuals wishing to expand knowledge of autism & sensory integration

High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management:

Course:

• Program, equine, and facility management.

This workshop will include lectures and discussion to: • Increase your awareness of Autism and Sensory Processing considerations in equine assisted activities.

• Business management, marketing fundraising, & board development.

• Enhance your instructor tool box with new therapeutic riding techniques specialized for participants with autism and sensory processing needs.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

• Further understand the impact of Autism on participants’ perspective and ability to adapt to the TR environment.

Time:

9:00am - 5:00pm

Price:

$125 includes light lunch

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

To Register:

Please complete attached forms and send them with the fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org or register online at http://www.highhopestr.org

Reg. Deadline: January 24, 2019 Course Materials: Will be provided at the workshop Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _ In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

Sensory Integration and Autism Workshop HIGH HOPES THERAPEUTIC RIDING INC. CONTINUING EDUCATION High Hopes Therapeutic Riding Inc. Registration Form

Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________ Zip: ________________ Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: _________________ (e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following workshop: Sensory Integration & Autism Workshop ____________ February 9, 2019 Fee: $125.00 (inc. light lunch) Registration cost includes: A light lunch Cancellation and Refund Policy: High Hopes reserves the right to cancel the workshop and/or the skills test/certification up to 5 business days after the registration deadline on the front of this flyer due to insufficient registrants or unforseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations prior to the registration deadline will receive a full refund minus a $75 service fee. No reimbursements will be granted after the registration deadline.

I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨ I consent ¨ I Do Not Consent _ Date:________________________ Consent Signture:_____________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

INTENTIONALLY BLANK PAGE

BEYOND ESMHL - Next Steps!

Date:

February 16 - 18, 2019

PATH Int’l CEUs 2 ESMHL CR; 6 DE, 8 CE About:

Faculty:

This workshop offers opportunities beyond the PATH Intl.

ESMHL course and is designed for EAAT professionals seeking an interactive, hands-on, educational, networking experience.

It will enhance their understanding of the benefits of Equine Assisted Learning and Equine Assisted Psychotherapy and present more tools for future lessons or sessions.

Amanda Hogan, PATH Intl. Master Therapeutic Riding Instructor, ESMHL Co-author of ESMHL Curriculum/Workshop & Susanne Haseman, MEd, LCMHC, CEIP-MH, ESMHL and PATH Intl. Advanced Therapeutic Riding Instructor.

Who should attend? • Equine Facilitated Learning (EFL) or Equine Facilitated Psychotherapy (EFP) • Equine Professionals • Therapeutic Riding Instructors • Anyone who works with mental health &

education professionals and their clients/participants Course:

This workshop will include lecture discussion and hands on horse experience to:

• Expand your toolbox of mutually beneficial equine assisted activities that can be utilized in mental health and learning lessons or sessions

• Collaborate with other professionals to develop treatment and education goals and to design safe and effective lessons or sessions

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

• Discuss and select equines to work with different students/client in sessions that we design and implement in the workshop, as well as selection of equines for particular clients/students at their centers

• Observe equine communication and discuss its use in equine assisted learning and therapy

• Explore language which can be utilized to describe equine assisted activities for marketing or recruitment efforts

High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies:

Deadline: Register by January 23, 2019 To Register:

Please complete attached forms and send them with the fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org or register online at http://www.highhopestr.org

Time:

February 16 (6-8pm), February 17—18 (8am-5pm)

Price:

$325 includes a light breakfast and lunch

• P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

Course Materials: Provided at the workshop Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

BEYOND ESMHL HIGH HOPES THERAPEUTIC RIDING INC. CONTINUING EDUCATION HIGH HOPES THERAPEUTIC RIDING, Inc. REGISTRATION FORM Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________ Zip: ________________ Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: __________________ _(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following workshop: Beyond ESMHL ______________ February 16-18, 2019 Fee: $325.00 Registration cost includes: A light breakfast and lunch Cancellation and Refund Policy: High Hopes reserves the right to cancel the workshop and/or the skills test/certification up to 5 business days after the registration deadline on the front of this flyer due to insufficient registrants or unforseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations prior to the registration deadline will receive a full refund minus a $150 service fee. No reimbursements will be granted after the registration deadline. I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨ I consent ¨ I Do Not Consent _ Date:________________________ Consent Signture:_____________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

PATH INTL. EQUINE SPECIALIST MENTAL HEALTH AND LEARNING WORKSHOP & PRACTICAL HORSEMANSHIP SKILLS TEST Hosted by HIGH HOPES THERAPEUTIC RIDING, Inc.

THERAPEUTIC RIDING

DATE: February 16-18, 2019 Please attach another piece of paper or write on the back of this form if necessary to answer the following questions: • Are you a PATH Intl. Certified Therapeutic Riding Instructor?

If yes, what level or specialty: Registered, Advanced, Master, Driving?

• Equine Experience: Please tell us about any Certification you have with an Equine Organization (examples would be Pony Club, CHA, USDF, USEA, ARICP, Eagala, etc…) _Organization: _______________________________________________Level: ______________ Organization: _______________________________________________Level: ______________ Organization: _______________________________________________Level: ______________

• Do you have experience working with Mental Health or Special Education clients in any setting? If yes, please tell us where and what kind:

• Describe other equine experience you have:

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _ In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

Managing Challenging Behaviors to Increase Participant Success

Date:

March 16, 2019

PATH Int’l CEUs 7 DE About:

Faculty: High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

This workshop is ideal for those seeking an interactive experience to further their understanding of participant behavior and behavior management techniques utilized in the TR and EAAT setting. The objective of this workshop is to provide instructors with an understanding of the functions of behaviors, and how to utilize research based theories and strategies to respond to difficult situations.

Participants will work in small groups utilizing strategies to problem solve common issues in the EAAT setting. The topics build upon one another as the day progresses, so at the end of the day each participant can go home with the tools knowing the answer to the big question of, “What do I do when my participant does _________________?”

Kate McCormick, Special Educator, PATH Intl. Registered Therapeutic Riding Instructor & ESMHL, who also specializes in behavioral assessment.

Who should attend? • PATH Int’l Therapeutic Riding Instructors • Mental Health Professionals • Education Professionals Course: This workshop will include discussion and practical exercises to

• Learn behavior management techniques that will most effectively help your EAAT participants meet their goals in a positive, successful, and safe manner.

• Delve into various behaviors experienced in the TR and EAAT settings stemming from a wide range of disabilities, such as ASD, Sensory Processing Disorder, and working with youth at-risk who struggle with conduct disorders, anxiety, and/or aggression.

Time:

9:00am - 5:00pm

Price:

$125 including light lunch

To Register:

Please complete attached forms and send with your fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org or register online at http://www.highhopestr.org

Reg. Deadline: February 2, 2019 Course Materials: Provided at the workshop Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

Managing Challenging Behaviors to Increase Participant Success HIGH HOPES THERAPEUTIC RIDING INC. CONTINUING EDUCATION HIGH HOPES THERAPEUTIC RIDING INC. REGISTRATION FORM Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________ Zip: ________________ Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: ___________________ _____(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following workshop: MANAGING CHALLENGING BEHAVIORS TO INCREASE PARTICIPANT SUCCESS MARCH 16, 2019 Fee: $125.00 Registration includes: A light lunch Cancellation and Refund Policy: High Hopes reserves the right to cancel the workshop and/or the skills test/certification up to 5 business days after the registration deadline on the front of this flyer due to insufficient registrants or unforseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations prior to the registration deadline will receive a full refund minus a $75 service fee. No reimbursements will be granted after the registration deadline.

I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨ I consent _

¨ I Do Not Consent

Date:________________________ Consent Signture:___________________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_ ____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _ In case of Emergency, contact: (Parent if minor)_ _ ___________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

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Always by Your Side - Strategies in Volunteer Management

Date:

March 23-24, 2019

PATH Int’l CEUs Day 1 - 7 CE; Day 2 - 7 Riding CR About:

An interactive two-day workshop designed to help you develop strategies and techniques for managing volunteer resources. Day one is suitable for ALL TYPES of non-profit.

Day 1 Administrative Volunteer Management: Recruit—Train—Schedule—Retain Day 2 Instructional Volunteer Management Program specific training Program volunteer placement (leaders, sidewalkers, etc.), Solution/team base approach to managing volunteers in therapeutic riding Faculty:

High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

Amy Tripson, PATH Intl. Advanced Therapeutic Riding Instructor and High Hopes Volunteer Manager

Megan Ellis, PATH Intl. Advanced Therapeutic Riding Instructor and High Hopes Program Director Who should attend? Anyone who wishes to learn more about volunteer management:

• Volunteer Managers/Coordinators • Non Profit Program Administrators • Therapeutic Riding Instructors

Course:

Topics will include: • Recruitment, training and retention • Fostering volunteer relationships • Managing volunteers for maximum effectiveness • Volunteer program evaluation • Data tracking and more!

Time:

9:00am - 5:00pm

Price:

$150 for each day including light lunch or $275 for 2 days

To Register:

Please complete attached forms and send them with the fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org or register online at http://www.highhopestr.org

• PATH Intl. Master, Advanced and Specialty Certified mentors.

Reg. Deadline: February 22, 2019

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

Course Materials: Any needed will be provided at the workshop Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

Always by your Side - Strategies in Volunteer Management Workshop HIGH HOPES THERAPEUTIC RIDING INC. CONTINUING EDUCATION HIGH HOPES THERAPEUTIC RIDING, Inc. REGISTRATION FORM Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________ Zip: _____________ Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: ____________________ _(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following workshop: Volunteer Management Workshop Days 1 & 2_______________ _March 23-24, 2019 Fee: $275 Volunteer Management Workshop Day 1___________________ _March 23, 2019 Fee: $150 Volunteer Management Workshop Day 2___________________ _March 24, 2019 Fee: $150 Registration includes: A light lunch Cancellation and Refund Policy: High Hopes reserves the right to cancel the workshop and/or the skills test/certification up to 5 business days after the registration deadline on the front of this flyer due to insufficient registrants or unforseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations prior to the registration deadline will receive a full refund minus a $75 service fee. No reimbursements will be granted after the registration deadline.

I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨I consent ¨ I Do Not Consent Date:________________________ Consent Signture:___________________________________________

Please describe your interest and experience with volunteers: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _ In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I

hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff permission before taking any pictures or videos. I have read and understand High Hopes Confiden-

tiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability or handicap, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We are however required to provide demographic information, including ethnicity, age & disability to many of the bodies that award grants or provide us with accreditation. This is in order for us to demonstrate our diversity and anti-discrimination ethos.

We would therefore be grateful if, you would complete the following: Ethnicity:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

INTENTIONALLY BLANK PAGE

The Therapy Horse

Date:

March 25, 2019

PATH Int’l CEUs 7 CE About:

Faculty:

Equine selection and training are central to the success of our therapeutic horsemanship programs. Join our staff in a conversation about finding the right equine for your program’s needs, training them for their unique roles and maintaining their well-being to ensure longevity in your herd.

Holly Sundmaker, High Hopes Equine Operations Director

Who should attend? Anyone who wishes to learn more about equine management in a therapeutic riding setting:

High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management:

• • • •

Course:

Topics will include:

• Recruiting and selecting the right horses for your program • Planning a trial period • Tailored training systems to create willing partners • Stress control: management techniques for happy horses • Life beyond the TR Center

Time:

9:00am - 5:00pm

Price:

$125 including light lunch

• Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies:

Equine Managers Program Directors Therapeutic Riding Instructors Equine Specialists and more….

To Register:

Please complete attached forms and send them with the fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org or register online at http://www.highhopestr.org

• P _ ATH Intl. Premier Accredited Center since 1979.

Reg. Deadline: March 1, 2019

• PATH Intl. Approved Instructor Training Course since 1996.

Course Materials: Will be provided at the workshop

• PATH Intl. Master, Advanced and Specialty Certified mentors.

Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

The Therapy Horse Workshop HIGH HOPES THERAPEUTIC RIDING INC. CONTINUING EDUCATION HIGH HOPES THERAPEUTIC RIDING, Inc. REGISTRATION FORM

Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________ Zip: ________________ Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: ____________________ (e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following workshop: Therapy Horse Workshop ______________________March 25, 2019 Fee: $125.00 Registration cost includes: A light lunch Cancellation and Refund Policy: High Hopes reserves the right to cancel the workshop and/or the skills test/certification up to 5 business days after the registration deadline on the front of this flyer due to insufficient registrants or unforseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations prior to the registration deadline will receive a full refund minus a $75 service fee. No reimbursements will be granted after the registration deadline.

I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨ I consent ¨ I Do Not Consent _ Date:________________________ Consent Signture:_____________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _ In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

INTENTIONALLY BLANK PAGE

Non-Profit Business, Development & Administrative Workshop

Date:

On Demand

PATH Int’l CEUs 12 CE About:

An interactive two-day workshop designed to help you meet your organization’s management, fundraising and communication needs. This workshop explores best practices in non-profit management, offers practical learning opportunities, case studies, and networking with peers.

Both days are suitable for ALL TYPES of non-profit.

Day 1: Nonprofit Business Administration: Develop an understanding of and utilize solid management practices that will ensure your organization survives and thrives in today’s economy. Topics to include: - Best management practices - Committee and Board Relationships - Organizational Mission, Vision and Values - Operations Management - Strategic Planning - Financial Management High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

Day 2: Fundraising and Communications. Build a well-rounded fundraising program to ensure long term financial sustainability. Topics to include: - Building a donor base - Appeal Program - Major Gifts - Grant Research and Writing - Special Events - Planned Giving - Cultivating Donor Relationships Faculty:

Kitty Stalsburg, High Hopes Executive Director Lesley Olsen, High Hopes Finance Director Sara Qua, High Hopes Development Director

Time:

9:00am - 5:00pm

Price:

Varies with number of participants - please call for a quote

Course Materials: Will be provided at the workshop To Register:

Please complete attached forms and send them with the fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x124 Attn: Patti Coyle, pcoyle@highhhopestr.org or register your interest online at http://www.highhopestr.org

Reg. Deadline: Call for more information Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

Non-Profit Business, Development & Non-Profit Management Workshop HIGH HOPES THERAPEUTIC RIDING INC. CONTINUING EDUCATION HIGH HOPES THERAPEUTIC RIDING, Inc. REGISTRATION FORM

Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________ Zip: _____________ Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: _____________________ _(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: _______________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following workshop: Two Day Workshop preferred dates _ a)_______________________ or_ b) ______________________ Fee: $tbc* Day One of the Workshop preferred dates_ a)_______________________ or_ b) ______________________ Fee: $tbc* Day Two of the Workshop preferred dates a)_______________________ or_ b) ______________________ Fee: $tbc* Cost: to be confirmed, based on the number of participants. Call for a quote.

Registration cost includes: A light lunch Cancellation and Refund Policy: High Hopes reserves the right to cancel all or any part of the workshop and/ or certification due to unforeseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations for on demand workshops and/or certifications up to 14 days before the first workshop /certification day, will receive a full refund minus a $150 service fee. No reimbursements will be granted after this. I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨

I consent _

¨ I Do Not Consent

Date:________________________ Consent Signture:___________________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _ In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

INTENTIONALLY BLANK PAGE

PATH Intl. Equine Specialist in Mental Health & Learning (ESMHL)

Workshop Dates: November 16-18, 2018 or April 13-15, 2019 Skills Test Dates: November 19, 2018 or April 16, 2019 PATH Int’l CEUs 2 ESMHL CR; 6 DE, 12 CE About: The Equine Specialist in Mental Health & Learning workshop is a three-day workshop offered to equine professionals and therapeutic riding instructors who work or would like to work with students with mental health and/ or learning issues. The workshop is a requirement of the ESMHL certification. It is beneficial to have horsemanship skills and experience when attending the workshop but it is not required. The Horsemanship Skills Test is held on day 4 following the ESMHL workshop.

Faculty:

High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

Amanda Hogan, PATH Int’l Master Therapeutic Riding Instructor, ESMHL and Co-author of ESMHL Curriculum/Workshop & Susanne Haseman, MEd, LCMHC, CEIP-MH, ESMHL and PATH, Int’l Advanced Therapeutic Riding Instructor.

Who should attend?

• Equine Facilitated Learning (EFL) or Equine Facilitated Psychotherapy (EFP) • Equine Professionals • Therapeutic Riding Instructors • Anyone who works with mental health & education professionals and their clients.

Prerequisites: • 21 or older • Current PATH Intl. individual member • Equestrian skills on the flat in English or Western tack comparable to those described in Pony Club C or CHA Level I • Familiarity with PATH Intl. Standards and PATH Intl.

Code of Ethics, and/or a PATH Intl. Certified Therapeutic Riding Instructor Deadline: October 11, 2018 (for Nov)/March 6, 2019 (for April) To Register: Please complete attached forms and send with your fee* to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371 Attn: Sarah Carlson, call (860) 434-1974 x115, scarlson@highhhopestr.org or register online at http://www.highhopestr.org Time: 8:00am – 5:30pm Price: • Workshop Only: $475.00* • Workshop & Horsemanship Skills Test: $625.00* Inc. light breakfast & lunch on days 1-3 (workshop days) • Horsemanship Skills Test Only: $150.00 Course Materials: Workshop Manual will be provided Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

PATH INTL. EQUINE SPECIALIST MENTAL HEALTH AND LEARNING WORKSHOP & PRACTICAL HORSEMANSHIP SKILLS TEST HIGH HOPES THERAPEUTIC RIDING, Inc. REGISTRATION FORM Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________

Zip: ________________

Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: __________________ _(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following (NOTE there is a maximum of 20 participants for each workshop/skills test): *Workshop ONLY $475.00 ________________ Nov 16-18, 2018 ________________ April 13-15, 2019

*Workshop & Horsemanship Skills Test $625.00__________ Nov 16-19, 2018 _______________ April 13-16, 2019

*Horsemanship Skills Test ONLY $150.00 __________ Nov 19, 2018 ________________ April 16, 2019

The workshop is 3 full days, 8am to 5.30pm. Cost includes breakfast and light lunch on workshop days. The skills test will take place on day four, no breakfast or lunch provided on this day.

All participants must download a copy of the ESMHL certification booklet and bring it to the workshop and skills test. The booklet is available at http://www.pathintl.org/images/pdf/resources/certifications/PATH-Intl-ESMHL-Certification-Booklet. pdf. A limited number of booklets will also be available at the workshop for an additional $15 fee.

Check all that apply: ¨ I am at least 21 years old ¨ I am a current PATH Intl. Member ¨ I have called the PATH Intl. office to pay any membership fees needed (if applicable) ¨ I do not need an accommodation of any kind to complete the practical testing ¨ I do need an accommodation to complete the practical testing and have contacted the PATH Intl. office to request it.

Date:_______________________________ Signture:___________________________________________

Cancellation and Refund Policy: High Hopes reserves the right to cancel the workshop and/or the skills test/certification up to 5 business days after the registration deadline on the front of this flyer due to insufficient registrants or unforseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations prior to the registration deadline will receive a full refund minus a $150 service fee. No reimbursements will be granted after the registration deadline. I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨I consent ¨ I Do Not Consent Date:________________________ Consent Signture:___________________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

PATH INTL. EQUINE SPECIALIST MENTAL HEALTH AND LEARNING WORKSHOP & PRACTICAL HORSEMANSHIP SKILLS TEST Hosted by HIGH HOPES THERAPEUTIC RIDING, Inc.

THERAPEUTIC RIDING

DATE:

November 16-19, 2018

or

April 13-16, 2019

(please circle)

Please attach another piece of paper or write on the back of this form if necessary to answer the following questions: • Are you a PATH Intl. Certified Therapeutic Riding Instructor?

If yes, what level or specialty: Registered, Advanced, Master, Driving?

• Equine Experience: Please tell us about any Certification you have with an Equine Organization (examples would be Pony Club, CHA, USDF, USEA, ARICP, Eagala, etc…) _Organization: _______________________________________________Level: ______________ Organization: _______________________________________________Level: ______________ Organization: _______________________________________________Level: ______________

• Do you have experience working with Mental Health or Special Education clients in any setting? If yes, please tell us where and what kind:

• Describe other equine experience you have:

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks

and potential for risks of horseback riding and related equine activities including grievous bodily

harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than High Hopes staff. Volunteers must seek staff

permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer

PATH Intl. On-site Workshop & Certification - REGISTERED Instructor Level -

Workshop Dates: November 12-14, 2018 or June 12-14, 2019 Certification Dates: November 14-15, 2018 or June 14-15, 2019 PATH Int’l CEUs 6 DE, 2CR, 12 CE About:

This workshop and certification is designed to provide information for those exploring a career in Therapeutic Riding. For those who meet the prerequisites for PATH Intl. certification the workshop also provides an intensive preparation. Please check the PATH Intl. website for all qualifying steps if you are registering for certification.

Faculty Liz Adams PATH Intl. Advanced Instructor/Lead Evaluator Megan Ellis PATH Intl. Advanced Instructor/Lead Evaluator Faculty - subject to change Who should attend? Anyone interested in learning more about becoming a PATH Intl. Registered Instructor or who wishes to prepare for their Registered Instructor Certification.

Time: 8:30am – 5:00pm High Hopes has 45 years of demonstrated success in the field of EAAT & non-profit management: • Program, equine, and facility management.

• Business management, marketing fundraising, & board development.

• Volunteer management.

We have over 650 volunteers serving our program, facility, equines & development.

Workshops, certifications and professional development in all aspects of Equine Assisted Activities & Therapies: • P _ ATH Intl. Premier Accredited Center since 1979.

• PATH Intl. Approved Instructor Training Course since 1996.

• PATH Intl. Master, Advanced and Specialty Certified mentors.

• F ull service indoor and outdoor facility, extensive sensory trails and a dedicated air-conditioned classroom and kitchen facility.

Price:

• •

•

Instructor Workshop ONLY: $525.00 inc. light lunch Instructor Workshop inc. light lunch AND One-Day Certification $725.00 Certification ONLY: $425.00

Prerequisites: • FOR WORKSHOP PATH INTL. membership required • FOR CERTIFICATION you must: - be 18 or older - be a current PATH Intl. individual member - PATH Intl. Phase 1 completed within last 12 months - PATH Intl. Phase 2 evidence of 25 hours teaching mounted therapeutic riding lessons under the supervision/mentorship of a current PATH Intl

Certified Instructor - have attended a PATH Intl. Approved On-site Workshop in the last 2 years.

Reg. Deadline: Oct. 5, 2018 for November May 3 for June 2019 (max 20 for w/s, 12 for cert.)

To Register: Please complete attached forms and send them together with the required fee AND a copy of your PATH Intl.

Instructor-In-Training letter with the fee to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371.

(860) 434-1974 x115 Attn: Sarah Carlson, scarlson@highhhopestr.org

Course Materials: Will be provided at workshop Terms: Please check our website for terms & conditions and cancellation policy at https://www.highhopestr.org

PATH INTL. ONSITE WORKSHOP AND REGISTERED INSTRUCTOR CERTIFICATION High Hopes Therapeutic Riding Inc. Registration Form Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________ Zip: ________________ Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Program Affiliation: __________________ _(e.g. High Hopes TR, etc.)

How did you hear about this workshop?

Role or position: ________________________

Facebook ¨ E-Blast ¨ List Serve ¨_PATH CC ¨ Strides ¨ Other Ad ¨

Please register me for the following (NB: maximum of 20 participants for each workshop but only 12 for the skills test):

Workshop* ONLY $525.00

Workshop* & Certification^ $725.00

Certification ONLY^ $425.00

________________ Nov. 12-14, 2018 ________________ June 12-14, 2019

________________ Nov. 12-15, 2018 ________________ June 12-15, 2019

________________ November 15, 2018 ________________ June 15, 2019

The workshop is 3 full days, 8am to 5pm. This includes a light breakfast and lunch each day. * Workshop includes light lunch on workshop days only. ^ You must provide proof of having attended a PATH Intl. Approved On-Site Workshop in the last two years For certification please note that High Hopes Horses have a weight limit of 180lbs. We do require a submission of a riding video prior to confirmation from candidates at or over 165 lbs. Submission of the video is for the center to ensure we can accommodate all candidates during their mounted ride for certification. This video will be reviewed by our center representative and will not be utilized for evaluation. If you exceed this weight limit, you will need to contact PATH Intl. for accommodation requirements of the riding portion of certification.

Cancellation and Refund Policy: High Hopes reserves the right to cancel the workshop and/or the skills test/certification up to 5 business days after the registration deadline on the front of this flyer due to insufficient registrants or unforseen circumstances. In that case all paid registration fees will be refunded in full. Participant cancellations prior to the registration deadline will receive a full refund minus a $150 service fee. No reimbursements will be granted after the registration deadline. I have read, understand and accept all High Hopes terms, conditions and cancellation/refund policies in this registration form and on the High Hopes website http://www.highhopestr.org ¨ I consent ¨ I Do Not Consent _ Date:________________________ Consent Signture:___________________________________________

FOR CERTIFICATION Candidates ONLY please check and complete the following: ¨ I am at least 18 years old ¨ I am a current PATH Intl. Member HEIGHT____________________ WEIGHT_________________________ Preferred riding discipline ¨ English ¨ Western Date:_______________________________________ Signature: ___________________________________

Please mail to: High Hopes Therapeutic Riding, Inc. 36 Town Woods Road , Old Lyme, CT 06371. Attn: Sarah Carlson, or register online at http://www.highhopestr.org. Upon receipt of this completed form and payment, High Hopes will send you an official letter of welcome and any additional materials necessary.

For questions contact Sarah Carlson at (860) 434-1974 ext. 115, or scarlson@highhopestr.org.

HORSEMANSHIP & EDUCATIONAL EXPERIENCE FORM Please type or print clearly in ink.

Please include a copy of your actual resume as well. (this information will be shared with your Host Site Representative) THERAPEUTIC RIDING

CONTACT Name: ________________________________________________PATH Intl. Yes/No______Membership No.________________ Mailing Address: ___________________________________________________________ City: _____________________________________________________ State: _______________ Zip: ________________ Phone (Day) ________________________ Phone (Cell) _______________________Email:_________________________ Affiliated with the following operating center: _________________________________________ _(e.g. High Hopes TR, etc.)

Role or position: ________________________________________________ Are you a licensed therapist? PT ¨ OT ¨ Other Therapist _________________________________________ EDUCATION High School_______________________________________ Year:___________________ Diploma______________ College or vocational_______________________________ Year:___________________ Diploma______________ Other Studies/Certificates/License:________________________________________________________________ Work Experience related to disabilities (other than therapeutic riding):___________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ EQUESTRIAN BACKGROUND Number of years riding: _______ _Owning a horse: _____________ _Number of years giving riding instruction:______ Type(s) of instruction:___________________________________________________________________________ 4-H level:___________________ Describe your equine experience:_________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ EXPERIENCE TEACHING RIDERS WITH DISABILITIES (check any and all that apply to your experience) ¨

Impairments

¨

Autism

¨

Spina Bifida

¨

Learning Disabilities

¨

Down Syndrome

¨

Stroke/CVA

¨

Communication impairment

¨

Cerebral Palsy

¨

Post-Polio

¨

Hearing impairment

¨

Multiple Sclerosis

¨

¨

Visual impairment

¨

Muscular Dystrophy

¨

Emotional impairment

¨

Brain Injury/Head Trauma

Other________________________ ________________________________ ________________________________ _________________________________

ADDITIONAL INFORMATION Professional organizations of which you are a member_________________________________________________ ____________________________________________________________________________________________ Articles/Books/Lectures you have done:____________________________________________________________ ____________________________________________________________________________________________

HIGH HOPES THERAPEUTIC RIDING INC REGISTRATION & RELEASE PLEASE COMPLETE ENTIRE FORM Please Check One: Visitor: _¨ Brd/Cmt Member:_¨ Spec Event Volunteer:_ ¨ One Day Vol/Group: ¨ T&E course visitor: ¨ Name:______________ Home #:_____________________ Cell #:______________________ DOB:______________ Address: ___________________________ Town:________________________________ State/zip______________ Email: _____________________ _ In case of Emergency, contact: (Parent if minor)_ ____________________ Phone: Please indicate any medical conditions or medications we should be aware of in the event of an emergency: ____________________________________________________________________________________________ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to: Secure and retain medical treatment and transportation, if needed and release records upon request to the authorized individual or agency involved in the medical emergency treatment.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONSENT PLAN* (to be invoked in the event that your Emergency Contact cannot be reached) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.

Date:______________________ _Consent Signture(s):__________________________________________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

*If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.

PHOTO VIDEO & PUBLICITY RELEASE PHOTO VIDEO & PUBLICITY RELEASE

High Hopes takes the privacy of our participants, their families, volunteers, visitors and staff seriously. At the same time we value the use of real images in the promotional and reporting activities which enable us to provide subsidized therapeutic activities. By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/ my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of your image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.

¨I consent ¨ I Do Not Consent Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

LIABILITY RELEASE: I acknowledge the risks and potential for risks of horseback riding and

related equine activities including grievous bodily harm. However, I feel that the possible benefits to myself are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating as a High Hopes volunteer from whatever cause, including but not limited to the negligence of these related parties. The undersigned acknowledges that he/she has read this Volunteer Application in its entirety; that he/ she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.

Date:________________________________ Consent Signture:______________________ Consent Signture:______________________ I_f volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

CONFIDENTIALITY POLICY:

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential Information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other

than High Hopes staff. Volunteers must seek staff permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.

Date:________________________________ Consent Signture:______________________ _Consent Signture:______________________ _If volunteer is under 18 years of age, both parent & volunteer/visitor signatures are required.

DIVERSITY & ANTI-DISCRIMINATION:

At High Hopes, everyone is welcome. We do not discriminate on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability, sex, gender, gender identity and/or expression (including a transgender identity), sexual orientation, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law. We would be grateful if, you would complete the following to help us ensure we live our intent:

¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨

White Hispanic, Latino or Spanish Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Other race or ethnicity

¨

Prefer not to answer