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Little Breeches Spring 2025 Application Form (ages 9-12)

Program Description
Little Breeches is an inclusive farm-based program for children aged 9-12 years old. This program provides the opportunity for children to visit the Sunrise farm to learn about horses and participate in horse care and other activities such as:
- Weekly seasonal and horse-related themes
- Interactive and hands-on activities
- Grooming, leading, washing the miniature horses

- EAL (Equine Assisted Learning)
- Poop n' Scoop
- Crafts
- Outdoor games
- Playground
- Archery
- Low Ropes

Participant Name

Gender & Pronouns

Birth date

YYYY

Height

Weight

Weight limit for riding is 170 pounds

Parent/Guardian Name:

Cell Phone:

Work Phone:

Parent/Guardian Name:

Cell Phone:

Work Phone:

Address

Home Phone

Confirm Email Address

Session Selection

Fall 2024- Sundays April 13th, April 27th, May 11th, Ride Day: May 25th

Afternoon (1:30pm-3:30pm): Little Breeches Ages 9-12$140.005 choices left

Emergency Contact Information

Emergency Contact

Please avoid listing parents/guardians.

Emergency Contact Cell Phone

Emergency Contact Home Phone

Authorized People to Pick Up

Please list all people that are able to pick up this camper, including yourself. Government approved Photo ID (Driver's Licence, Health Card or Passport) needs to be shown at pickup every Sunday in order for a child to leave Sunrise. Sunrise cannot send a child home with someone that is not listed below.

Name

Camper Information

Is the participant

New to Little Breeches

Returning to Little Breeches

New to Little Breeches but has been a Sunrise Camper

Does the participant have a special need/diagnosis?

Yes

Please explain diagnosis:

Does the participant have any behavioural and/or emotional challenges?

Yes

Please explain behavioural and/or emotional challenges:

If yes, the emotional and or behavioural challenges need to be explained below.

Please add what may work best or how we can help to work through challenges.

Will your camper be attending with a PSW/support worker?

If yes, please contact our Camp Coordinator at

campcoordinator@sunrise-therapeutic.ca with contact information for the support worker.

Clear choice

Yes

Not sure (please contact campcoordinator@sunrise-therapeutic.ca for further information)

New campers with physical and or developmental disabilities or behavioural/emotional challenges must complete an Individual Profile. New campers with special needs/emotional/behavioural needs will be required to come to Sunrise for a PSW Assessment and get to know you visit with the Camp Coordinator before attending camp. Families with children with health needs are required to contact our Camp Coordinator to provide further information.

Health Information

Health Card Number

Family Physician

Has the participant ever had a seizure?

Yes

Type

Date of last seizure

Please list any health conditions:

Does the participant require medication to be administered during program?

If your child requires medication to be administered at Little Breeches, this Medical Dispensing Form needs to be filled out by a parent or guardian in order for the medication to be given. Medication must be sent in the original labeled container and must be kept in a secure location during camp hours.

Yes

Does the participant have any allergies?

Yes

If yes, please list allergies:

Is an Epi-Pen required?

Yes

Any additional information about the participant:

Photo Release

Sunrise may use pictures and/or videotapes of the child in public display and promotion. This may include but is not limited to social media, website and marketing materials.

Yes

Sunrise Therapeutic Riding & Learning Centre Waiver, Assumption of Risk & Release of Liability

All boxes need to be selected in order for the waiver to be valid and completed.

Select allClear choices

I agree as a precondition to my participation or the participation of my child in horse riding/driving/vaulting/grooming/equine facilitated wellness and any other activity involving horses (hereafter called “Equine Activities”) organized by Sunrise Therapeutic Riding & Learning Centre (Sunrise) and conducted by Sunrise or their employees or volunteers and in further consideration of being permitted to do so to be strictly bound by the terms of this Waiver, Assumption of Risk and Release of Liability.

I enter into this agreement with Sunrise recognizing that “Equine Activities” is inherently a risky undertaking, due to the sometimes unpredictable behaviour of horses, regardless of their continual training and past reliable performance.

I understand that all Sunrise instructors are certified through the Canadian Therapeutic Riding Association (CanTRA) or other equivalent national associations or there may be a student instructor, working under the direction of a fully certified instructor.

I understand that all participants must wear an ASTM (American Society for Testing and Materials) approved riding helmet.

I am aware that there are inherent dangers, hazards and risks (collectively “Risks”) associated with “Equine Activities” and injuries may result from these “Risks”. I am aware that the “Risks” of “Equine Activities” mean those dangerous conditions which are an integral part of “Equine Activities”, including but not limited to: A). The propensity of any equine to behave in ways that may result in injury, harm, or death to persons on or around them and to potentially collide with, bite or kick other animals, people or objects. B). The unpredictability of an equine’s reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects. C). The potential for other participants to behave in a negligent manner that may contribute to injury to themselves or others, including failing to act within their abilities to maintain control over an equine.

I agree that this Waiver, Assumption of Risk and Release of Liability and all terms contained herein are governed exclusively and in all respects by the laws of the province or territory of Canada in which the "Equine Activities" are provided by Sunrise. I hereby irrevocably submit to the exclusive jurisdiction of the courts of that province or territory of Canada and I agree that no other court can exercise this jurisdiction over the terms and claims referred to herein. Any litigation to enforce this waiver will be instituted in the province or territory of Canada in which the "Equine Activities" are provided by Sunrise.

I have read this entire Waiver, Assumption of Risk and Release of Liability document. I understand it is a promise to release Sunrise, its Directors, Officers, employees, volunteers and agents and the owners of the land upon which Sunrise operates from, all claims wheresoever or howsoever arising now or in future. I have made a free and deliberate choice to sign this Waiver, Assumption of Risk and Release of Liability as a condition to allow me or my child to engage in “Equine Activities” organized by Sunrise Therapeutic Riding & Learning Centre (Sunrise).

Signature for Waiver

Clear

Terms & Conditions

1. Sunrise reserves the right to not accept or to remove a participant from our program whose behavior is an imminent risk to themselves and/or other children at Sunrise. If we contact you to come get your child, it is mandatory that you come pick your child up.

2. Sunrise reserves the right to not accept or to remove a participant from our program who is sick/feeling unwell. If we contact you to come get your child, it is mandatory that you come pick your child up. We do not want anyone to get sick and want to ensure that all of our participants remain safe.

3. If the participant should need emergency medical treatment and Sunrise staff are unable to contact the parents/guardians listed or our emergency contact, I, the parent/guardian, give consent for the Sunrise staff to act on our behalf, on the understanding that every effort will continue to be made to reach the emergency contacts.

4. Sunrise will follow all Public Health regulations regarding COVID-19 and will share our protocols for the program with participant families prior to starting. Protocols may change throughout the fall. Sunrise will notify participant parents/guardians of updates to the COVID-19 protocols via email. No refunds will be given as a result of a positive COVID-19 case or exposure resulting in the participant not being able to attend the program.

5. Sunrise Policy R-10 – Degree of Bodily Contact When Working with Clients
It is understood that instructors and trained volunteers may need to physically assist riders when mounting, dismounting and/or while riding a horse. Any bodily contact provided by trained staff or personal care workers is in the interest of providing a safe and fun environment for children, and will be undertaken with the utmost discretion. If a Sunrise participant’s behaviour becomes an imminent risk to themselves or any other individual, trained staff may be required to perform a physical restraint and remove the participant to a safer location. Staff will follow all guidelines as per the Crisis Prevention Institute’s Nonviolent Crisis Intervention Training. Physical contact is only used as a last resort and when all verbal means of managing the situation have been exhausted and will be done with the safety, dignity and well-being for the participant and others in mind.

6. New Participant (with a special need or a diagnosis) Info:
If your child is new to Sunrise and has a special need/diagnosis, both the child and the parent(s)/guardian(s) will need to come to Sunrise before Little Breeches begins to do a PSW Assessment. The assessment includes a tour of Sunrise and we will decide whether or not your child needs to have a support worker/PSW when attending Little Breeches. If you are unable to find a support worker, you will be refunded. These assessments occur once the registration form, all other forms applicable and payment has been made.

7. If your child has a special need/diagnosis: (New or Returning Child)
This Individual Profile Form must be completed in order for your application to be complete. This form can be completed by a parent or guardian.

8. If your child has a special need/diagnosis that impacts their physical health:
This Physician's Referral Form in order to be approved for riding. This form can only be filled out by a physician.

9. If your child requires medication to be administered at Little Breeches, the Medical Dispensing Form needs to be filled out by a parent or guardian in order for the medication to be given.

10. If your child comes to Camp Sunrise with a PSW/support worker, then they will need to have one at Little Breeches.

11. We are a peanut/nut-free facility. Participants are not allowed to bring peanut/nut food products to Sunrise.

Terms and Conditions

I have read and agree to the Terms and Conditions.

Electronic signature

By signing here you agree to all above terms and conditions.

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Payment Method & Terms

In order to reserve your camper's spot, please ensure full payment is made within 24 hours of submitting this form unless payment is through a funding agency. If this presents a barrier to you, please contact Jenna.

The submission button below will open a Square payment page. If you selected Credit via Square, please pay here. If a different payment option was selected, the Square page can be closed.

Credit via Square (click purchase on the following screen after you have submitted the form)

E-transfer (please send promptly to lynne@sunrise-therapeutic.ca and make the password LittleBreeches

Cheque (please contact Jenna at campcoordinator@sunrise-therapeutic.ca

Funding Agency (please contact Jenna at campcoordinator@sunrise-therapeutic.ca)

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