WAIVER FORM for Equine Skills, Level 1

Name:

Date:

The undersigned instructor, manager or program director attests to the ability and skill of the above named therapist in the following areas of basic horsemanship:

Ø Able to identify parts of a snaffle bridle.

Ø Able to identify the following parts of the horse: pastern, stifle, croup, dock, withers, cannon bone, hoof, fetlock, throatlatch, shoulders, hock, poll, barrel, crest, knee, back, flank and cheekbone.

Ø Able to identify parts of the hoof: wall, sole, whiteline, toe, coronary band, heel frog and bar.

Ø Able to safely halter a horse and lead out of stall; to safely secure in grooming area of barn.

Ø Able to safely groom and pick out hooves of a horse.

Ø Able to demonstrate tacking up with a bridle, saddle and surcingle.

Ø Able to safely lead a horse in hand with a halter and lead rope in an arena.

Ø Able to safely untack a horse and return to stall or paddock.

Ø Identifies the two blind spots on a horse.

Ø Identifies the footfalls of the walk, trot and canter.

Ø Knows the terminology of nearside, offside, tracking up and over tracking.

Ø Identify the signs of burnout in a horse and how to prevent it.

Ø Identify a well-conditioned horse with good nutrition from a poorly conditioned horse.

Name and professional expertise or designation:

Date:

Please include the following contact information should faculty from the American Hippotherapy Association, Inc. need to contact you.

Address:

Phone:

Email: