Heavenly Hooves Program Participant Application

All participants will also be required to sign a hardcopy of the Health History at evaluation.

Please indicate current or past special needs in the following areas:

Describe your abilities/difficulties in the following areas (include assistance required or equipment needed).

This Health History is up-to-date and accurate, to the best of my knowledge.

All participants will also be required to sign a hardcopy of the photo release at evaluation.

consent to and authorize the use and reproduction by Heavenly Hooves, Inc. (DBA McCormick Research Institute) of any and all photographs and any other audio/visual materials taken of me/my son/my daughter/my ward for promotional printed material, educational activities, or for any other use for the benefit of the program.

All participants will also be required to sign a hardcopy of the Liability Release at evaluation.

 

Know all men by these presents, that

Participant with parent or legal guardian’s consent hereby desires to engage in the following equine activity, to wit: HEAVENLY HOOVES/MCCORMICK RESEARCH INSTITUTE, located in Osceola County, Florida. For and in consideration of the above activities and services; receipt and sufficiency of which is hereby acknowledged, Participant/Participant’s parent/legal guardian hereby does forever and finally release, remise, acquit, satisfy, and forever discharge Osceola County (Florida) and all related entities including Osceola County Board of Commissioners, and all of their past, present and future partners, owners, directors, officers, shareholders, representatives, agents, and employees, and all of their respective successors and assigns, individually and in their official capacities (collectively, "Released Parties") and McCormick Research Institute Inc., (dba Heavenly Hooves) a Florida Corporation and all related entities; officers, directors, agents, sponsors and employees of and from all manner of action and actions; cause and causes of action, suit, debts, dues, sums of money, bonds, billings, contracts, controversies, agreements, promises, damages, variances, judgments, executions, claims, and demands whatsoever, in law or in equity, which may arise or might in the future arise, herein after may arise for or against the equine activity sponsor for the activities stated above. This document is meant to be a full and complete release from any and all liability that may arise from participating in the above described equine activity, or from any activity the participant may engage on the equine activity sponsor’s and Osceola County property in preparation for the above described equine activity. This release is given freely and voluntarily by the parent/legal guardian of participant and is meant to remain in existence throughout the period prior to and throughout the duration of the equine activity.

 

 

Under Florida law, an equine activity sponsor or equine professional is not liable for any injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities. FLORIDA STATE STATUTECHAPTER 773.

 

 

This release and indemnity has been carefully and fully read by the undersigned, and the undersigned fully understands its terms and conditions, and has voluntarily executed and delivered this release of indemnity as of

parent/legal guardian of

have read the above release and indemnity in full, and I consent and agree with the terms set forth. I fully understand its terms and conditions, and I hereby voluntarily execute and deliver this release and indemnity and consent to

participation in the activities. I further agree to be fully bound by the terms and conditions of the Release and Indemnity in both my individual capacity and in my capacity as parent/legal guardian for the individual as indicated above.

All participants will also be required to sign a hardcopy of the Liability Release at evaluation.

 

Know all men by these presents, that

Participant with parent or legal guardian’s consent hereby desires to engage in the following equine activity, to wit: HEAVENLY HOOVES/MCCORMICK RESEARCH INSTITUTE, located in Osceola County, Florida. For and in consideration of the above activities and services; receipt and sufficiency of which is hereby acknowledged, Participant/Participant’s parent/legal guardian hereby does forever and finally release, remise, acquit, satisfy, and forever discharge Osceola County (Florida) and all related entities including Osceola County Board of Commissioners, and all of their past, present and future partners, owners, directors, officers, shareholders, representatives, agents, and employees, and all of their respective successors and assigns, individually and in their official capacities (collectively, "Released Parties") and McCormick Research Institute Inc., (dba Heavenly Hooves) a Florida Corporation and all related entities; officers, directors, agents, sponsors and employees of and from all manner of action and actions; cause and causes of action, suit, debts, dues, sums of money, bonds, billings, contracts, controversies, agreements, promises, damages, variances, judgments, executions, claims, and demands whatsoever, in law or in equity, which may arise or might in the future arise, herein after may arise for or against the equine activity sponsor for the activities stated above. This document is meant to be a full and complete release from any and all liability that may arise from participating in the above described equine activity, or from any activity the participant may engage on the equine activity sponsor’s and Osceola County property in preparation for the above described equine activity. This release is given freely and voluntarily by the parent/legal guardian of participant and is meant to remain in existence throughout the period prior to and throughout the duration of the equine activity.

 

 

Under Florida law, an equine activity sponsor or equine professional is not liable for any injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities. FLORIDA STATE STATUTECHAPTER 773.

 

 

This release and indemnity has been carefully and fully read by the undersigned, and the undersigned fully understands its terms and conditions, and has voluntarily executed and delivered this release of indemnity as of

parent/legal guardian of

have read the above release and indemnity in full, and I consent and agree with the terms set forth. I fully understand its terms and conditions, and I hereby voluntarily execute and deliver this release and indemnity and consent to

participation in the activities. I further agree to be fully bound by the terms and conditions of the Release and Indemnity in both my individual capacity and in my capacity as parent/legal guardian for the individual as indicated above.

All participants will also be required to sign a hardcopy of this form, which will be supplied at evaluation.

 

If emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on Heavenly Hooves' property, I authorize Heavenly Hooves, Inc. to:

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

 

    

This authorization includes x-ray, surgery, hospitalization, medication, and any treatment procedure deemed "life-saving" by the physician. This provision will only be invoked if the person below is unable to be reached.

I do not give my consent for emergency medical treatment/aid in the case of illness or injury during the process of receiving services or while being on the property of McCormick Research Institute. If emergency treatment/aid is required, I wish the following procedures to take place.

All participants will also be required to sign a hardcopy of this form, which will be supplied at evaluation.

 

If emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on Heavenly Hooves' property, I authorize Heavenly Hooves, Inc. to:

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

 

    

This authorization includes x-ray, surgery, hospitalization, medication, and any treatment procedure deemed "life-saving" by the physician. This provision will only be invoked if the person below is unable to be reached.

I do not give my consent for emergency medical treatment/aid in the case of illness or injury during the process of receiving services or while being on the property of McCormick Research Institute. If emergency treatment/aid is required, I wish the following procedures to take place.

Prior to evaluation, every participant must have their physician fill out a Participant's Medical History form. This form can be downloaded from our website or obtained from the program director.

Prior to evaluation every participant must have their physician fill out a Physician's Statement. This form can be downloaded from our website or obtained from the program director.

I understand that I must have the participant's physician sign the Participant's Medical History form and the Physician's Statement prior to evaluation for the Heavenly Hooves program.

About McCormick

4651 Rummell Road
St. Cloud, FL 34771
407-933-7433 (RIDE)
© 2017 McCormick Research Institute, Heavenly Hooves, Horses and Heroes. All Rights Reserved.