Client Forms

You will find here all the forms you need to get signed up for a Session at HorsePower!

Client paperwork for any session is now due 14 weeks prior to the start date of that session. Please check the “Schedule/Events” page for exact dates.

Please read through the prompts below, starting in “Section I – NEW” to find the grouping of forms you will need to get signed up for an upcoming HorsePower Session. All our sessions are 8 weeks long. New forms are due once a year for everyone, unless your Physician has signed off on a longer period of time, and/or your Occupational or Physical Therapists (if applicable) have signed off on a longer period of time. Please contact us if you are unsure of your paperwork expiration date.

If you have any questions regarding enrollment, forms, or the date your Physician’s release or Therapist’s release goes to, please don’t hesitate to call the barn: 605-251-1685, or email: OfficeAdmin@HorsePowerSF.com.  Included in the set of forms are Physical Therapy and Occupational Therapy forms. Even if your participant does not receive these services, those forms must be returned. In this case, please write their name on them, and write “Does Not Apply” if they do not receive those services.  Also, please note that proper placement into a HorsePower program is dependent upon review of the paperwork, history, &/or an assessment. Placement is not guaranteed. All forms MUST be completed and returned to us in order to participate.

Please note these policies in the payment contract: To get a paid in full discount on non-scholarship accounts: Return your packet of forms on time (approximately 3 months before the session starts), and not only do you lock in your spot, but you get a 5% discount if you pay your session in full by the first week of lessons! Otherwise, payment for the entire session is expected by the end of the session. If you should need to set up payments beyond the length of your session, there will be a $5 monthly billing fee for each month beyond the end of your session. Please call Marisa Draper at: (605)480-0344 or feel free to email: Marisa.Draper@HorsePowerSF.com with any questions, including any questions about the current balance of past earned fundraiser credits available for use on your account.

HorsePower does have a Scholarship Fund to help defray the costs of participation for those who qualify. Should you need scholarship assistance for tuition, please fill out and return the scholarship application along with the other forms. If a scholarship is granted, there will be a minimum of $5 per session due from the client as their “co-pay.” This set of forms is listed in each category as “(Optional)”.

Section I – NEW

Are you a new participant? If yes, continue in this section. If not, skip this section and move on to Section II – RETURNING.

Forms necessary for new participants enrolling in a session:

1.   Client Registration

2.   Letter to Physician and Medical Release

3.   Authorization for Emergency Medical Treatment

4.   OT and PT Forms

5.   Liability & Photo Release

6.  Payment Contract – 8 week session

client-schedule-form-8-week-session

8. (Optional) Scholarship information letter &  Scholarship App (new)

Section II – RETURNING, CONTINUOUSLY ENROLLED

These forms are necessary for returning participants who have been continuously enrolled since their last full set of paperwork was turned in. If you have not been enrolled in every session since your last full set of forms have been turned in, and your forms have not expired, please move down to Section III.

1.   Payment Contract – 8 week session

2. client-schedule-form-8-week-session

3.   (Optional) Scholarship information letter &  Scholarship App (new)

Section III – RETURNING, NON-CONTINUOUSLY ENROLLED

These forms are necessary for returning participants who have NOT been continuously enrolled in HorsePower sessions since their last full set of forms were turned in, but whose forms have not expired yet. If your forms have expired, please return to Section I and download and turn in those forms.

1.   Continue validity of paperwork

2.   Payment Contract – 8 week session

3.   Client schedule form 8 week session

4.  (Optional) Scholarship information letter &  Scholarship App (new)

Credits Available:client-schedule-form-8-week-session

(Last updated 11/30/16)

Number Unearned Svc Rev Fundraiser Credit Total
112 100 100
115 16 16
123 55.5 55.5
125 60 60
133 24 580.45 604.45
137 730.69 730.69
138 16 16
145 18.83 18.83
147 1488 1488
148 8.15 8.15
149 96 96
150 22.5 22.5
152 2.5 2.5
161 364.62 364.62
165 22.5 22.5
168 124.56 124.56
179 5 5
184 50 50
187 60 60
190 85.5 85.5
203 177 177
208 346 346
221 10 43.2 53.2
254 837.5 837.5
258 110 110
271 50.34 50.34
275 250 250
276 16.5 16.5
280 7.88 7.88
282 10.68 10.68
287 5 5
288 10 10
288 10 10
289 171 171
292 40.5 40.5
294 52.05 52.05
305 60 60
318 24 24
336 106.86 108.66
341 7.5 40.17 47.67
351 1678.77 1678.77
352 5 5
357 30 30
369 8.68 8.68
371 203.82 203.82
375 10 10
380 570 570
383 7.5 7.5
384 10 10
385 10 10
388 1.5 1.5
398 5.57 60.64 66.21
442 68.15 68.15
60 18 78
Advertisements
  1. I do like the detailed instructions, but could you please have an option that would allow you to print everything with one click? Thank you!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: