Participant's Name *

First Name

Last Name

I understand that this information all personal information will be stored securely and kept confidential. *

Yes

No

Halifax Lancers is committed to fostering an environment of belonging where all people can enjoy the amazing benefits of interacting with horses while feeling respected, valued, safe, and welcome. The following questions are being asked to help us better understand the ethnicity, gender identification, or disability of the future riders on our waitlist. Halifax Lancers wants to foster an environment of belonging for all people and we are committed to making our membership reflective of those on our waitlist and of the population of Halifax. *

Ethnicity

Asian/South Asian

Middle Eastern/Arabic

Latino or Hispanic

Indigenous/Mi’kmaq

African

Black

White

Other

Prefer not the answer

Are you newly immigrated to Canada (0-3 years)? *

Yes

No

Prefer not to answer

Participant's pronouns *

She/Her

He/Him

They/Them

Other

Prefer not to answer

Ableism *

Please tell us more about the medical conditions/disabilities of the participant as this will assist us determine the most appropriate experience for the participant

Sensory impairment (vision or hearing)

Physical impairment (e.g. multiple sclerosis, cerebral palsy, epilepsy)

Learning disability (e.g., ADHD, dyslexia)

Social/Emotional challenges

Other

None

I understand that riding horses may be contraindicated for some conditions *

Yes, I understand

I understand that some seizure activity may prevent riders from being permitted to ride for a period of time. *

Yes, I understand

The Lancer program is volunteer intensive and can only operate because of the skills, effort, and passion of its volunteers. The program is for participants who are not able to participate in “traditional” riding programs and need adaptation and support that the Halifax Lancers Therapeutic Riding program provides (e.g. 1 - 3 volunteers per rider) and would not be available at other riding facilities. *

Yes, I understand

I understand that new riders may be offered a space to participate in our non-riding/mounted lessons. *

Yes, I understand

I understand that to participate in the Therapeutic Riding program participants must: *

Be at least aged five

Have the ability to sit up / hold themselves upright.

Be able to follow directions

I understand that participants are not required to have grip strength to hold reins but that it is helpful to have *

Yes, I understand

I understand that all new participants must participate in an assessment to ensure that the program will meet their needs and goals and will be safe. It is possible that they will not be accepted into the program based on the assessment. *

Yes, I understand

If selected, I understand that once there is a space to register for the program, all participants must submit a medical form completed by an appropriate medical professional prior to the start of the program. *

Yes, I understand

I understand that all participants must participate in a weigh-in before each session. For the health and safety of the horses, riders, and volunteers, we do have weight restrictions. (If the participants weight exceeds what the safe for the horses, they will not be able to participate in an mounted horse session) *

Yes

I understand that spots in the program are limited and there are two six-week sessions that run in the autumn and spring. Lessons run only on Friday afternoons and Sunday mornings. I understand that participants are assigned a lesson slot and do not have a choice of their lesson day or time. Once the schedule has been established, changes to ride times/days cannot be accommodated. *

Yes

I understand that participants register for both autumn and spring sessions and lesson fees are paid monthly (September - July inclusive) by pre-authorized debit. Financial assistance is available if required, however, there is a minimum amount each participant must pay *

Yes

If or when some potential or current program participants wish to improve skills and experience beyond the scope of what the therapeutic riding program can safely offer (e.g. regular trotting, cantering or jumping), these riders may decide to enroll in a more suitable program. Halifax Lancers may be able to recommend programs to better suit the riders' needs. This discussion will be ongoing between the coach, health professionals, administration, volunteers, riders and their support people. *

Yes, I understand

I understand that Lancers has high demand and limited capacity so it may be a number of years before there is a space for me/ my child to participate. *

Yes, I understand

I understand that Lancers usually contacts individuals on the waitlist once a year to confirm they wish to remain on the waitlist. If I have not heard from Lancers, it means there is not yet a space for me / my child to register. I also understand that I am welcome to contact Lancers to ensure me/ my child is still on the waitlist. *

Yes, I understand