Participant Assessment

Please complete the following survey for participants starting traditional riding lessons, therapeutic riding or recreational therapy services

If you are human, leave this field blank.

Participant Assessment

Instructions:

This assessment is required for everyone that has newly registered for riding lessons or Recreational Therapy. Upon review of your completed assessment, the Camp Red Cedar staff will contact the participant for program options. If this assessment in not returned, we will not be able to schedule the participant at this time.

Email address: *

Participant Name: *

Parent/Guardian Name: *

Please check ALL risk areas below that apply to participant listed above:

Participant is at a higher risk due to having an underlying medical condition. Vulnerable populations as defined by the CDC include: Cancer, Chronic kidney disease, COPD Obesity (body mass index [BMI] of 30 or higher), Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies, Sickle cell disease, Asthma (moderate-to-severe), Cerebrovascular disease, Cystic fibrosis, Hypertension or high blood pressure, Immunocompromised state (weakened immune system) from blood, bone marrow or solid organ transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines, Neurologic conditions, such as dementia, Liver disease, Pregnancy, Pulmonary fibrosis, Smoking, Thalassemia, and/or Diabetes mellitus.

Participant is unable to comply with wearing a mask or would be bothered by others around them wearing a mask.

Participant is over age 60

Participant struggles to maintain safe distancing with others OR requires someone to be within reach of them at all times.

Participant touches face/mouth frequently

Participant has seasonal allergies that cause coughing or sneezing.

Participant drools frequently

Participant requires physical support for mounting or dismounting

Participant requires one or more side walkers to physically support them at the walk

Participant requires one or more side walkers for emotional/cognitive support or if at risk of seizure

Participant is prone to elopement and may require physical redirection for lessons

None of the above apply to participant

Other

Please describe any \"other conditions\" that may apply from previous question:

Are you interested in attending Recreational Therapy services when riding may not be an option?

Yes

No

Ex. grooming and tacking

Are you interested in attending telemed services versus face-to-face services?

Yes

No

Ex. video calls, skype, facetime

Do you have any comments/concerns about Recreational Therapy services? If so, please share.

Submit

Camp Red Cedar’s programs are CARF (Commission on Accreditation of Rehabilitation Facilities) accredited, the only PATH, Intl. (Professional Association of Therapeutic Horsemanship International) Premier Accredited Center in Northeastern Indiana, is a member of the Certified Horsemanship Association and the Indiana Horse Council.