The Pony Express Programs Questionnaire

Please fill and submit the form below

The Pony Express Ranch Participants Code of Ethics

● Steward your thoughts; practice mindfulness.

● Choose a loving speech.
● Listen with heart awareness.
● Cultivate compassionate behavior.
● Be Present-100% -mentally, physically, emotionally, and spiritually.
● A participant seeks feedback, continues to learn and is open to counsel from others in the equine-facilitated experiential learning field.
● A participant practices abstinence from mind and mood-altering chemicals when engaged in equine-facilitated experiential learning process work.
● A participant always has the best interest of the horses and the humans at the core of all interactions. Safety and conscious engagement are the underpinnings of all interactions.
● A participant “lives” the PE Safety Agreement. I am…..and I agree to be responsible for myself today (mentally, physically, emotionally, and spiritually). I remember to ask for help-support in consciousness.

The Pony Express Programs Questionnaire

Email *

Your Name *

Children's Name *

What is it that brought you here?

Pony intention? Agreement

What is your heart’s desire?

What do you think you lack?

What is your intention?

Do you have judgments, and can you set them aside?

How can I help you?

What would you like to learn more about?

The Pony Express Program Safety Agreement Section *

The Safety Agreement is foundational to personal growth and awareness. Horses always live in response to their own senses and in doing so, contribute to the safety of their herd.

By signing your name, you agree to be responsible for yourself, spiritually, emotionally, and physically. And in doing so, you contribute to the safety of the group.

The Pony Express Ranch Release of Liability *

I ________________________________ , am fully aware and fully understand that all horses are unpredictable and dangerous. I realize that placing my children, or myself in a stables environment is creating a hazardous situation.

The Pony Express Ranch Release of Liability *

Initial____I understand that riding horses or ponies is a dangerous sport. I am aware that riders must expect to be injured from time to time. I understand that the death of people from equestrian accidents is possible.

The Pony Express Ranch Release of Liability *

Initial_____I realize that professional instruction cannot prevent serious injury or death from working around, handling, or riding horses and ponies.

The Pony Express Ranch Release of Liability *

Initial_____I understand that jumping horses or ponies is a particularly dangerous activity and that serious injury or death of riders or horses is possible.

The Pony Express Ranch Release of Liability *

Initial_____I am aware that serious injury or death of my mount is possible when it is handled, trained, or in a lesson.

The Pony Express Ranch Release of Liability *

Initial_____The Pony Express, its owners, employees, and associates, have my permission to initiate emergency first aid treatment for my children, my animals, and myself in case of an accident. They also have my permission to authorize emergency medical treatment by qualified medical personnel for my children or myself, and veterinary treatment by qualified veterinary personnel for my animals.

The Pony Express Ranch Release of Liability *

Initial_____I understand that I am fully responsible for any guests that I may have on the property. I understand that I am fully responsible for fully informing the guest of all risks related to the handling or riding of horses. I understand that I am fully responsible for informing guests about horse's temperament, training, habits, and for determining that the guest is sufficiently experienced to ride the horse.

The Pony Express Ranch Release of Liability *

Initial_____I have carefully read each paragraph listed above and understand its contents.

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