{"id":219,"date":"2024-07-30T16:39:17","date_gmt":"2024-07-30T16:39:17","guid":{"rendered":"https:\/\/filemanageit.xyz\/upload\/?page_id=219"},"modified":"2024-08-17T22:09:02","modified_gmt":"2024-08-17T22:09:02","slug":"caring-corral-majestic-equine-connections-signup-for-volunteers","status":"publish","type":"page","link":"https:\/\/filemanageit.xyz\/upload\/caring-corral-majestic-equine-connections-signup-for-volunteers\/","title":{"rendered":"Caring Corral\/Majestic Equine Connections Signup for Volunteers"},"content":{"rendered":"\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-full is-style-default\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"191\" data-id=\"237\" src=\"https:\/\/filemanageit.xyz\/upload\/wp-content\/uploads\/2024\/07\/caringandmajestic-2.jpg\" alt=\"\" class=\"wp-image-237\" srcset=\"https:\/\/filemanageit.xyz\/upload\/wp-content\/uploads\/2024\/07\/caringandmajestic-2.jpg 600w, https:\/\/filemanageit.xyz\/upload\/wp-content\/uploads\/2024\/07\/caringandmajestic-2-300x96.jpg 300w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><\/figure>\n<\/figure>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-4a9afbc9-82a5-41ae-a6d9-f8c54072fe57 wpforms-render-modern\" id=\"wpforms-221\"><form id=\"wpforms-form-221\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"221\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/upload\/wp-json\/wp\/v2\/pages\/219\" data-token=\"c1b110bf1765a0c33358bbb13041160e\" data-token-time=\"1777732327\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-221-field_11-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"11\"><div id=\"wpforms-221-field_11\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_11-error\"><p>Required photo release, Emergency release, and Horse Liability<br \/>\nRelease Forms.<br \/>\nAL ASSESSMENT WITH INDIVIDUAL INTERESTED IN SERVICES. THE SESSIONS WILL BE FILLED<br \/>\nFIRST-COME, FIRST SERVED BASIS AS APPROPRIATE.<\/p>\n<p>PHOTOS|MARKETING RELEASES<br \/>\nRelease For: Majestic Equine Connections, Inc.| I willingly accept photos\/videos releases to be public for<br \/>\npublicity purposes for Majestic Equine Connections, Inc. and The Caring Corral during participation in activities or on property for<br \/>\nservices. This may include but not limited to: Facebook, website, on news-television, magazine,<br \/>\ninstagram, display boards, Linkedin, audio\/movie recordings, and\/or any publicity purposes associated<br \/>\nwith Majestic Horse or Majestic Equine Connections, inc.. The purpose is for marketing the program and<br \/>\npromotional reasons for grants, funding, enlisting new participants, and volunteers.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_22-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_22\">Do you agree to our Photos and Marketing Policies? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-221-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" required=\"required\"><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-221-field_14-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">Participants Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_14\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][14][first]\" aria-errormessage=\"wpforms-221-field_14-error\" required><label for=\"wpforms-221-field_14\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_14-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][14][last]\" aria-errormessage=\"wpforms-221-field_14-last-error\" required><label for=\"wpforms-221-field_14-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_19-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Guardian Signature 18 or older (type in) or N\/A  (copy) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_19\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][19][first]\" aria-errormessage=\"wpforms-221-field_19-error\" required><label for=\"wpforms-221-field_19\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_19-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][19][last]\" aria-errormessage=\"wpforms-221-field_19-last-error\" required><label for=\"wpforms-221-field_19-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_16-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_16\">Phone<\/label><input type=\"tel\" id=\"wpforms-221-field_16\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][16]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-221-field_16-error\" ><\/div><div id=\"wpforms-221-field_23-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"23\"><div id=\"wpforms-221-field_23\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_23-error\"><p>____________________________________________________________________________________<br \/>\nEmergency Contacts are required for clients and volunteers in case of an emergency. Two Emergency<br \/>\nContacts are required and the 3rd is helpful if the first two do not answer the phone. Yes, you have my<br \/>\npermission to call emergency services if there is an emergency. This will be an option if the<br \/>\ncaregiver or guardian is not listed above and is not available through a phone call.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_24-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">Guardian\/Self Signature <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_24\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][24][first]\" aria-errormessage=\"wpforms-221-field_24-error\" required><label for=\"wpforms-221-field_24\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_24-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][24][last]\" aria-errormessage=\"wpforms-221-field_24-last-error\" required><label for=\"wpforms-221-field_24-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_25-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"25\"><fieldset><legend class=\"wpforms-field-label\">Date \/ Time of Signature <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-221-field_25\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][25][date]\" aria-errormessage=\"wpforms-221-field_25-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-221-field_25\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-221-field_25-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][25][time]\" aria-errormessage=\"wpforms-221-field_25-time-error\" required><label for=\"wpforms-221-field_25-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_30-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_30\">Diabetes Alert <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-221-field_30\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][30]\" aria-errormessage=\"wpforms-221-field_30-error\" aria-describedby=\"wpforms-221-field_30-description\" required><div id=\"wpforms-221-field_30-description\" class=\"wpforms-field-description\">Type in any diabetes alerts or just type N\/A<\/div><\/div><div id=\"wpforms-221-field_37-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_37\">Allergy Alert <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-221-field_37\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][37]\" aria-errormessage=\"wpforms-221-field_37-error\" aria-describedby=\"wpforms-221-field_37-description\" required><div id=\"wpforms-221-field_37-description\" class=\"wpforms-field-description\">Type in any allergy alerts or just type N\/A<\/div><\/div><div id=\"wpforms-221-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_36\">Seizure Alert <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-221-field_36\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-221-field_36-error\" aria-describedby=\"wpforms-221-field_36-description\" required><div id=\"wpforms-221-field_36-description\" class=\"wpforms-field-description\">Type in any seizure alerts or just type N\/A<\/div><\/div><div id=\"wpforms-221-field_31-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_31\">Added Info (STUNTS) or N\/A <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-221-field_31\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][31]\" aria-errormessage=\"wpforms-221-field_31-error\" required><\/div><div id=\"wpforms-221-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_34\">Insurance Name|#ID_ <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-221-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-221-field_34-error\" required><\/div><div id=\"wpforms-221-field_35-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_35\"> Preferred Hospital <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-221-field_35\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][35]\" aria-errormessage=\"wpforms-221-field_35-error\" required><\/div><div id=\"wpforms-221-field_26-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"26\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-221-field_28-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Emergency Contact #1 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_28\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][28][first]\" aria-errormessage=\"wpforms-221-field_28-error\" aria-describedby=\"wpforms-221-field_28-description\" required><label for=\"wpforms-221-field_28\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_28-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][28][last]\" aria-errormessage=\"wpforms-221-field_28-last-error\" aria-describedby=\"wpforms-221-field_28-description\" required><label for=\"wpforms-221-field_28-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-221-field_28-description\" class=\"wpforms-field-description\">Example, grandparent<\/div><\/fieldset><\/div><div id=\"wpforms-221-field_40-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"40\"><fieldset><legend class=\"wpforms-field-label\">Contact 1 Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-221-field_40\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][40][address1]\" aria-errormessage=\"wpforms-221-field_40-error\" required><label for=\"wpforms-221-field_40\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-221-field_40-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][40][address2]\" aria-errormessage=\"wpforms-221-field_40-address2-error\" ><label for=\"wpforms-221-field_40-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-221-field_40-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][40][city]\" aria-errormessage=\"wpforms-221-field_40-city-error\" required><label for=\"wpforms-221-field_40-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-221-field_40-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][40][state]\" aria-errormessage=\"wpforms-221-field_40-state-error\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-221-field_40-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-221-field_40-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][40][postal]\" aria-errormessage=\"wpforms-221-field_40-postal-error\" required><label for=\"wpforms-221-field_40-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-221-field_38-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"38\"><fieldset><legend class=\"wpforms-field-label\">Emergency Contact #2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_38\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][38][first]\" aria-errormessage=\"wpforms-221-field_38-error\" aria-describedby=\"wpforms-221-field_38-description\" required><label for=\"wpforms-221-field_38\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_38-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][38][last]\" aria-errormessage=\"wpforms-221-field_38-last-error\" aria-describedby=\"wpforms-221-field_38-description\" required><label for=\"wpforms-221-field_38-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-221-field_38-description\" class=\"wpforms-field-description\">Example, Aunt\/Uncle<\/div><\/fieldset><\/div><div id=\"wpforms-221-field_41-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"41\"><fieldset><legend class=\"wpforms-field-label\">Contact 2 Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-221-field_41\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][41][address1]\" aria-errormessage=\"wpforms-221-field_41-error\" required><label for=\"wpforms-221-field_41\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-221-field_41-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][41][address2]\" aria-errormessage=\"wpforms-221-field_41-address2-error\" ><label for=\"wpforms-221-field_41-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-221-field_41-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][41][city]\" aria-errormessage=\"wpforms-221-field_41-city-error\" required><label for=\"wpforms-221-field_41-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-221-field_41-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][41][state]\" aria-errormessage=\"wpforms-221-field_41-state-error\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-221-field_41-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-221-field_41-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][41][postal]\" aria-errormessage=\"wpforms-221-field_41-postal-error\" required><label for=\"wpforms-221-field_41-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-221-field_39-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"39\"><fieldset><legend class=\"wpforms-field-label\">Emergency Contact #3 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_39\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][39][first]\" aria-errormessage=\"wpforms-221-field_39-error\" aria-describedby=\"wpforms-221-field_39-description\" required><label for=\"wpforms-221-field_39\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_39-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][39][last]\" aria-errormessage=\"wpforms-221-field_39-last-error\" aria-describedby=\"wpforms-221-field_39-description\" required><label for=\"wpforms-221-field_39-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-221-field_39-description\" class=\"wpforms-field-description\">Example, Group Home Manager<\/div><\/fieldset><\/div><div id=\"wpforms-221-field_42-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"42\"><fieldset><legend class=\"wpforms-field-label\">Contact 3 Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-221-field_42\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][42][address1]\" aria-errormessage=\"wpforms-221-field_42-error\" required><label for=\"wpforms-221-field_42\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-221-field_42-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][42][address2]\" aria-errormessage=\"wpforms-221-field_42-address2-error\" ><label for=\"wpforms-221-field_42-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-221-field_42-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][42][city]\" aria-errormessage=\"wpforms-221-field_42-city-error\" required><label for=\"wpforms-221-field_42-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-221-field_42-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][42][state]\" aria-errormessage=\"wpforms-221-field_42-state-error\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-221-field_42-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-221-field_42-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][42][postal]\" aria-errormessage=\"wpforms-221-field_42-postal-error\" required><label for=\"wpforms-221-field_42-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-221-field_45-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"45\"><div id=\"wpforms-221-field_45\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_45-error\"><p>Majestic Equine Connections, Inc. has two addresses. Please contact Jennifer for which address<br \/>\nthe service will be held. The Westfield Road address is TBA for equestrian activities.<br \/>\n1. Current Horse Activities Address: 7460 Wooster Pike Rd. Seville, Ohio 44273<br \/>\n2. Chippewa Lake House: 7859 Westfield Road Medina, Ohio 44256 &#8211; NEW<br \/>\nA Partner with Medina County Parks District<\/p>\n<p><strong>Health History is different from physical.<\/strong><br \/>\n<strong>Client\/parent\/guardian can fill out without a physician<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_47-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"47\"><div id=\"wpforms-221-field_47\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_47-error\"><p><strong>HEALTH HISTORY<\/strong><\/p>\n<p><strong>Diagnosis: Date of Onset: Please indicate current or past special needs<br \/>\nin the following areas: Check box &amp; explain if applies.<br \/>\n<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_48-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_48\">Surgeries in the past 5 years. or type N\/A <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-221-field_48\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][48]\" aria-errormessage=\"wpforms-221-field_48-error\" required><\/div><div id=\"wpforms-221-field_49-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"49\"><fieldset><legend class=\"wpforms-field-label\">Checkboxes<\/legend><ul id=\"wpforms-221-field_49\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_1\" name=\"wpforms[fields][49][]\" value=\"Vision\" aria-errormessage=\"wpforms-221-field_49_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_1\">Vision<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_2\" name=\"wpforms[fields][49][]\" value=\"Hearing\" aria-errormessage=\"wpforms-221-field_49_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_2\">Hearing<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_9\" name=\"wpforms[fields][49][]\" value=\"Sensation\" aria-errormessage=\"wpforms-221-field_49_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_9\">Sensation<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_6\" name=\"wpforms[fields][49][]\" value=\"Communication\/Speech\" aria-errormessage=\"wpforms-221-field_49_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_6\">Communication\/Speech<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_5\" name=\"wpforms[fields][49][]\" value=\"Heart\" aria-errormessage=\"wpforms-221-field_49_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_5\">Heart<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_4\" name=\"wpforms[fields][49][]\" value=\"Breathing\" aria-errormessage=\"wpforms-221-field_49_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_4\">Breathing<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_10\" name=\"wpforms[fields][49][]\" value=\"Digestion\" aria-errormessage=\"wpforms-221-field_49_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_10\">Digestion<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_13\" name=\"wpforms[fields][49][]\" value=\"Elimination\" aria-errormessage=\"wpforms-221-field_49_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_13\">Elimination<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_12\" name=\"wpforms[fields][49][]\" value=\"Circulation\" aria-errormessage=\"wpforms-221-field_49_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_12\">Circulation<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_11\" name=\"wpforms[fields][49][]\" value=\"Emotional\/Mental Health (View Below)\" aria-errormessage=\"wpforms-221-field_49_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_11\">Emotional\/Mental Health (View Below)<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_16\" name=\"wpforms[fields][49][]\" value=\"Behavioral\" aria-errormessage=\"wpforms-221-field_49_16-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_16\">Behavioral<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_15\" name=\"wpforms[fields][49][]\" value=\"Pain\" aria-errormessage=\"wpforms-221-field_49_15-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_15\">Pain<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_14\" name=\"wpforms[fields][49][]\" value=\"Bone\/Joint\" aria-errormessage=\"wpforms-221-field_49_14-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_14\">Bone\/Joint<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_19\" name=\"wpforms[fields][49][]\" value=\"Muscular\" aria-errormessage=\"wpforms-221-field_49_19-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_19\">Muscular<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_20\" name=\"wpforms[fields][49][]\" value=\"Thinking\/Cognition\" aria-errormessage=\"wpforms-221-field_49_20-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_20\">Thinking\/Cognition<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_49_18\" name=\"wpforms[fields][49][]\" value=\"Allergies\" aria-errormessage=\"wpforms-221-field_49_18-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_49_18\">Allergies<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-221-field_50-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_50\">Please explain any of the boxes you checked above or type N\/A <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-221-field_50\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-221-field_50-error\" required><\/textarea><\/div><div id=\"wpforms-221-field_51-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"51\"><div id=\"wpforms-221-field_51\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_51-error\"><p>Pertains to Down Syndrome Only &#8211; Atlantoaxial Instability (Annual X ray Required) Only 10%-20%<br \/>\npersons with Down Syndrome have positive cases.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_52-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"52\"><fieldset><legend class=\"wpforms-field-label\"><\/legend><ul id=\"wpforms-221-field_52\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_52_1\" name=\"wpforms[fields][52][]\" value=\"Negative for neurological symptoms\" aria-errormessage=\"wpforms-221-field_52_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_52_1\">Negative for neurological symptoms<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_52_2\" name=\"wpforms[fields][52][]\" value=\"Negative X-ray\" aria-errormessage=\"wpforms-221-field_52_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_52_2\">Negative X-ray<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-221-field_53-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"53\"><fieldset><legend class=\"wpforms-field-label\">Mental Health History or Current Symptoms<\/legend><ul id=\"wpforms-221-field_53\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_1\" name=\"wpforms[fields][53][]\" value=\"Depression,\" aria-errormessage=\"wpforms-221-field_53_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_1\">Depression,<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_2\" name=\"wpforms[fields][53][]\" value=\"Anxiety\" aria-errormessage=\"wpforms-221-field_53_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_2\">Anxiety<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_9\" name=\"wpforms[fields][53][]\" value=\"Bi-polar\" aria-errormessage=\"wpforms-221-field_53_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_9\">Bi-polar<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_6\" name=\"wpforms[fields][53][]\" value=\"Schizophrenia\" aria-errormessage=\"wpforms-221-field_53_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_6\">Schizophrenia<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_5\" name=\"wpforms[fields][53][]\" value=\"Schizoaffective\" aria-errormessage=\"wpforms-221-field_53_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_5\">Schizoaffective<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_4\" name=\"wpforms[fields][53][]\" value=\"Post-Traumatic Stress Disorder\" aria-errormessage=\"wpforms-221-field_53_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_4\">Post-Traumatic Stress Disorder<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_10\" name=\"wpforms[fields][53][]\" value=\"Past Trauma\" aria-errormessage=\"wpforms-221-field_53_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_10\">Past Trauma<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_13\" name=\"wpforms[fields][53][]\" value=\"Loss of a love one recently or pet\" aria-errormessage=\"wpforms-221-field_53_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_13\">Loss of a love one recently or pet<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_12\" name=\"wpforms[fields][53][]\" value=\"OCD\" aria-errormessage=\"wpforms-221-field_53_12-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_12\">OCD<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_11\" name=\"wpforms[fields][53][]\" value=\"Other\" aria-errormessage=\"wpforms-221-field_53_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_11\">Other<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-221-field_53_16\" name=\"wpforms[fields][53][]\" value=\"Identify\/List Unhealthy Behaviors\" aria-errormessage=\"wpforms-221-field_53_16-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_53_16\">Identify\/List Unhealthy Behaviors<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-221-field_54-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_54\">Please explain any of the boxes you checked above or type N\/A <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-221-field_54\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-221-field_54-error\" required><\/textarea><\/div><div id=\"wpforms-221-field_55-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"55\"><div id=\"wpforms-221-field_55\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_55-error\"><h6><strong>Helpful information<\/strong><\/h6>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_56-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_56\">Likes and Dislikes <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-221-field_56\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][56]\" aria-errormessage=\"wpforms-221-field_56-error\" required><\/textarea><\/div><div id=\"wpforms-221-field_57-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_57\">Struggling\/Working through addiction? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-221-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-221-field_57-error\" required><\/textarea><\/div><div id=\"wpforms-221-field_58-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"58\"><div id=\"wpforms-221-field_58\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_58-error\"><p><strong>CAUTION: READ CAREFULLY BEFORE SIGNING. ONE SIGNED COPY REQUIRED FOR EACH<\/strong><br \/>\n<strong>INDIVIDUAL WHO PARTICIPATES IN AN ACTIVITY.<\/strong><\/p>\n<p>&nbsp;<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_60-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"60\"><div id=\"wpforms-221-field_60\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_60-error\"><p>I agree to the following Waiver, Agreement, and Liability Release with Majestic Equine Connections, Inc.<br \/>\nand\/or affiliated persons associated with the equine activities (referred to herein as &ldquo;The Property<br \/>\nOwners (&ldquo;Danny &amp; Jennifer Stankiewicz&rdquo;), as a condition for its allowing me, and the other persons<br \/>\nidentified below, to do any of the following: enter any premises or facility where equine activities are<br \/>\nconducted, be near horses in connection with any equine activities (handling, grooming, near, or riding<br \/>\nhorses). Agreement regardless of whether these activities take place under the supervision of &ldquo;The<br \/>\nProperty Owner and Lessee&rdquo; and its affiliates Majestic Equine Connections, Inc..at the following<br \/>\naddresses: 7460 Wooster Pike Rd. Seville, Ohio 44273 and 7859 Westfield Road Medina, Ohio 44256.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_61-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"61\"><fieldset><legend class=\"wpforms-field-label\">CONTRACTING PERSON(S) PARTICIPANT&#039;S NAME: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_61\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][61][first]\" aria-errormessage=\"wpforms-221-field_61-error\" required><label for=\"wpforms-221-field_61\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_61-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][61][last]\" aria-errormessage=\"wpforms-221-field_61-last-error\" required><label for=\"wpforms-221-field_61-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_62-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"62\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-221-field_62\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][62][date]\" aria-errormessage=\"wpforms-221-field_62-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-221-field_62\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-221-field_62-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][62][time]\" aria-errormessage=\"wpforms-221-field_62-time-error\" required><label for=\"wpforms-221-field_62-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_63-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_63\">SIGNATURE: (TYPE IN YOUR NAME) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-221-field_63\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][63]\" aria-errormessage=\"wpforms-221-field_63-error\" required><\/div><div id=\"wpforms-221-field_64-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"64\"><fieldset><legend class=\"wpforms-field-label\">Date \/ Time <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-221-field_64\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][64][date]\" aria-errormessage=\"wpforms-221-field_64-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-221-field_64\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-221-field_64-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][64][time]\" aria-errormessage=\"wpforms-221-field_64-time-error\" required><label for=\"wpforms-221-field_64-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_65-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_65\">Phone\/Cell <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-221-field_65\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][65]\" aria-label=\"Phone\/Cell\" aria-errormessage=\"wpforms-221-field_65-error\" required><\/div><div id=\"wpforms-221-field_66-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"66\"><fieldset><legend class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-221-field_66\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][66][address1]\" aria-errormessage=\"wpforms-221-field_66-error\" required><label for=\"wpforms-221-field_66\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-221-field_66-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][66][address2]\" aria-errormessage=\"wpforms-221-field_66-address2-error\" ><label for=\"wpforms-221-field_66-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-221-field_66-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][66][city]\" aria-errormessage=\"wpforms-221-field_66-city-error\" required><label for=\"wpforms-221-field_66-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-221-field_66-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][66][state]\" aria-errormessage=\"wpforms-221-field_66-state-error\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-221-field_66-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-221-field_66-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][66][postal]\" aria-errormessage=\"wpforms-221-field_66-postal-error\" required><label for=\"wpforms-221-field_66-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_67-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-221-field_67\">Parent\/Guardian SIGNATURE: or type N\/A <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-221-field_67\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][67]\" aria-errormessage=\"wpforms-221-field_67-error\" required><\/div><div id=\"wpforms-221-field_68-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"68\"><fieldset><legend class=\"wpforms-field-label\">Date \/ Time <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-221-field_68\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][68][date]\" aria-errormessage=\"wpforms-221-field_68-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-221-field_68\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-221-field_68-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][68][time]\" aria-errormessage=\"wpforms-221-field_68-time-error\" required><label for=\"wpforms-221-field_68-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_69-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"69\"><div id=\"wpforms-221-field_69\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_69-error\"><p><strong>Additional Participants with same Guardian\/Parent adding on: I also make this agreement of<\/strong><br \/>\n<strong>behalf of the following, who are my children or legal wards:<\/strong><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_70-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"70\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-221-field_71-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"71\"><fieldset><legend class=\"wpforms-field-label\">Name<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_71\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][71][first]\" aria-errormessage=\"wpforms-221-field_71-error\" ><label for=\"wpforms-221-field_71\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_71-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][71][last]\" aria-errormessage=\"wpforms-221-field_71-last-error\" ><label for=\"wpforms-221-field_71-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-221-field_73-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"73\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-221-field_73\" class=\"wpforms-field-date-time-date wpforms-datepicker\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][73][date]\" aria-errormessage=\"wpforms-221-field_73-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-221-field_73\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-221-field_73-time\" class=\"wpforms-field-date-time-time wpforms-timepicker\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][73][time]\" aria-errormessage=\"wpforms-221-field_73-time-error\" ><label for=\"wpforms-221-field_73-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-221-field_72-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"72\"><fieldset><legend class=\"wpforms-field-label\">Name<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_72\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][72][first]\" aria-errormessage=\"wpforms-221-field_72-error\" ><label for=\"wpforms-221-field_72\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_72-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][72][last]\" aria-errormessage=\"wpforms-221-field_72-last-error\" ><label for=\"wpforms-221-field_72-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-221-field_74-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"74\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-221-field_74\" class=\"wpforms-field-date-time-date wpforms-datepicker\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][74][date]\" aria-errormessage=\"wpforms-221-field_74-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-221-field_74\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-221-field_74-time\" class=\"wpforms-field-date-time-time wpforms-timepicker\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][74][time]\" aria-errormessage=\"wpforms-221-field_74-time-error\" ><label for=\"wpforms-221-field_74-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/fieldset><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-221-field_82-container\" class=\"wpforms-field wpforms-field-payment-checkbox\" data-field-id=\"82\"><fieldset><legend class=\"wpforms-field-label\">Please Choose which times you will be available for Volunteer Activities <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-221-field_82\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-221-field_82_1\" class=\"wpforms-payment-price\" data-amount=\"10.00\" name=\"wpforms[fields][82][]\" value=\"1\" aria-errormessage=\"wpforms-221-field_82_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_82_1\">Tuesdays 3:00 p.m. &#8211; 4:00 pm<\/label><\/li><li class=\"choice-2\"><input type=\"checkbox\" id=\"wpforms-221-field_82_2\" class=\"wpforms-payment-price\" data-amount=\"25.00\" name=\"wpforms[fields][82][]\" value=\"2\" aria-errormessage=\"wpforms-221-field_82_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_82_2\">Wednesdays 2:30 p.m. &#8211; 3:30 p.m.<\/label><\/li><li class=\"choice-3\"><input type=\"checkbox\" id=\"wpforms-221-field_82_3\" class=\"wpforms-payment-price\" data-amount=\"50.00\" name=\"wpforms[fields][82][]\" value=\"3\" aria-errormessage=\"wpforms-221-field_82_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-221-field_82_3\">Wednesdays 3:30 p.m. &#8211; 4:30 p.m.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-221-field_75-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"75\"><div id=\"wpforms-221-field_75\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_75-error\"><p>All parts of the Waiver, Agreement, and Liability Release shall apply to me, and the children\/legal<br \/>\nwards listed above. (We will collectively call ourselves \u201cI\u201d, \u201cme\u201d, or \u201cmy\u201d, throughout this<br \/>\nagreement.) This Waiver, Agreement, and Liability Release will be binding at all times, now and in<br \/>\nthe future, even after my relationship with \u201cThe property Owner\u201d.<br \/>\nRELEASE STATEMENT I understand that parts of the activities may be physically or emotionally<br \/>\ndemanding. I affirm that I (or the participant) am in good health and am not under a physician&#8217;s care for<br \/>\nany undisclosed condition that bears upon my (or their) ability to participate in this activity. I understand<br \/>\nthat \u201cThe property Owner\u201d will offer safety equipment such as helmets. I recognize the inherent risk or<br \/>\ninjury or disability and understand that each participant must assume the risk of physical injury that<br \/>\ncould result. I release \u201cThe property owners\u201d and volunteers from liabilities resulting from participating<br \/>\nin these activities. This release is governed by the State of Ohio.<br \/>\nWARNING Under the Ohio Equine Activity Liability Act, (Ohio Revised Code Chapter 2305.321) an equine<br \/>\nprofessional is not liable for an injury or the death of a participant in an equine activity resulting from an inherent<br \/>\nrisk of equine activity. It is mutually understood and agreed that the liability release set forth herein shall<br \/>\nconstitute a waiver of liability beyond the provisions of the Ohio equine activity liability act. By signing<br \/>\nthis agreement and liability release, I agree not to bring any claim or suit against \u201cThe property owner\u201d<br \/>\nor volunteers, affiliated persons, and others acting on their behalf on the basis of any exception in that law. It is my intention to release and hold harmless \u201cThe property owner\u201d or persons affiliated and<br \/>\nentities associated with \u201cThe property owner\u201d to the fullest extent allowed under the law.<br \/>\nHELMETS\/HEADGEAR I agree to be fully responsible for my own safety at all times. \u201cThe property<br \/>\nowner\u201d has suggested that I buy and wear a properly fitted ASTM-STANDARD\/SEI-CERTIFIED<br \/>\nEQUESTRIAN helmet when riding or near equines. I am not relying on \u201cThe property Owner\u201d to provide<br \/>\na certified helmet for me, to check any helmet or strap that I may wear, or to monitor my compliance<br \/>\nwith this suggestion at any time. LIABILITY RELEASE: As consideration for being to enter on property, to<br \/>\nbe near equines in connection with any \u201cThe property owner\/lessee\u201d activities (regardless of who owns<br \/>\nthe equines), and\/or engage in any other activity involving horses\/equines, whether or not under \u201cThe<br \/>\nproperty owner\u201d supervision, I agree to assume full responsibility for any and all bodily injuries or<br \/>\ndamages which I may sustain when engaging in these and other activities. The term \u201cdamages,\u201d means,<br \/>\nfor example, medical expenses, losses incurred because of bodily injuries or property damages, and\/or<br \/>\npersonal property damages. I, for my heirs, administrators, personal representatives or assigns, release<br \/>\nand discharge \u201cThe property owner\u201d and its affiliated persons, and others acting on their behalf of and<br \/>\nfrom any and all claims, demands, damages, actions, omissions, suits, or causes and action (present<br \/>\nand future), whether the same by known or unknown, anticipated omissions, suits, or causes of action<br \/>\n(present or future), whether the same by known or unknown, anticipated or unanticipated, resulting<br \/>\nfrom or arising out of my bodily injury or damage that may be<br \/>\nsustained, or property damage which may occur as a result of being on the property, handling horses,<br \/>\nbeing near horses, and\/or engaging in any other activity involving horses, whether or not under \u201cThe<br \/>\nproperty owner\u201d supervision. It is my intention to RELEASE\/WAIVER OR HOLD HARMLESS Danny &amp;<br \/>\nJennifer Stankiewicz (\u201cThe property Owner\u201d and Lessee) or persons AFFILIATED with equine activities<br \/>\nand\/or other animals at the following address:<br \/>\n7460 Wooster Pike Rd. Seville, Ohio 44273.<br \/>\n7859 Westfield Road Medina, Ohio 44256<br \/>\nEQUINE-RELATED RISKS: I understand that anyone riding, handling, or even near a horse (referred to as<br \/>\n\u201cequine\u201d) can suffer bodily and other injuries. Among other things, equines are unpredictable by nature.<br \/>\nFor example, frightened, angry, or under stress, the natural instincts of an equine are to jump forward or<br \/>\nsideways or run away from danger by trotting or galloping. Equines are also known to kick, buck, rear<br \/>\nup, back up quickly, spin around, strike, or bite. I know that equines can do any of these things without<br \/>\nwarning. I also understand that all equines, even if they have no known history of hurting people or<br \/>\nanimals, are powerful and can be dangerous to people, and other animals.<\/p>\n<h3>I fully read and agree with the above.<\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_76-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"76\"><fieldset><legend class=\"wpforms-field-label\">PARTICIPANT NAME <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_76\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][76][first]\" aria-errormessage=\"wpforms-221-field_76-error\" required><label for=\"wpforms-221-field_76\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_76-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][76][last]\" aria-errormessage=\"wpforms-221-field_76-last-error\" required><label for=\"wpforms-221-field_76-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_77-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"77\"><fieldset><legend class=\"wpforms-field-label\">Signature\/or Guardian <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_77\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][77][first]\" aria-errormessage=\"wpforms-221-field_77-error\" required><label for=\"wpforms-221-field_77\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-221-field_77-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][77][last]\" aria-errormessage=\"wpforms-221-field_77-last-error\" required><label for=\"wpforms-221-field_77-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_78-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"78\"><fieldset><legend class=\"wpforms-field-label\">Date \/ Time <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-221-field_78\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][78][date]\" aria-errormessage=\"wpforms-221-field_78-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-221-field_78\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-221-field_78-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][78][time]\" aria-errormessage=\"wpforms-221-field_78-time-error\" required><label for=\"wpforms-221-field_78-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-221-field_79-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"79\"><div id=\"wpforms-221-field_79\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_79-error\"><p>Under Ohio law (Ohio Revised Code Section 2305.321), horse owners and other parties are protected against<br \/>\nliability for injuries that occur as a consequence of an inherent risk of equine activity<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-221-field_80-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"80\"><div id=\"wpforms-221-field_80\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-221-field_80-error\"><p>Majestic Equine Connections, Inc. Rules-Code of Conduct:<br \/>\nhttps:\/\/majesticequineconnectionsinc.org<br \/>\nMajestic I : 7460 Wooster Pike Road Seville, Ohio 44273<br \/>\n\u25cf Please be Respectful to humans and animals. We have therapy horses and bunnies.<br \/>\n\u25cf Please be open to learning.<br \/>\n\u25cf Be kind with the use of language.<br \/>\n\u25cf Instructors Names: Katy or Jennifer<br \/>\n\u25cf Classes are up to 1-hour. Please be on time.<br \/>\nParking &#8211; In front of yellow barns in back. Please utilize turn-around in front of drive due to the<br \/>\n55 mph fast pace road (Wooster Pike\/Rt 3) for safety. No parking on the grass. Thank you!<br \/>\nWhat to Wear!<br \/>\n\u25cf Wear Closed-Toed Shoes such as boots with slight heel *Equestrian boots*, Older Pair<br \/>\nof Tennis Shoes, regular boots and\/or muck boots, trail shoes. (Tractor supply or<br \/>\nClothing Wearhouse has boots $5 or $10 bucks.<br \/>\n\u25cf May bring water, sunblock, wear hats. (We may have water bottles here).<br \/>\n\u25cf Summer : May wear t-shirts, tank-tops, shorts (non-riding) Winter: thick jackets and<br \/>\ngloves.<br \/>\nWhat NOT to Wear!<br \/>\n\u25cf High Heel boots, sandals, flip flops, new shoes, anything that has an open toe.<br \/>\n\u25cf Nothing too revealing with tops or high shorts.<br \/>\n\u25cf No vulgar messages on clothes.<br \/>\nWe are friendly and kind here. We hope you enjoy our services!<strong> Thank you to the<\/strong><br \/>\n<strong>Caring Corral\u2019s partnership!<\/strong><br \/>\nMAIL TO: Majestic Equine Connections, Inc.,7460 Wooster Pike Rd. Seville, Ohio 44273 or email<br \/>\nmajesticequineconnections@gmail.com<br \/>\nPH (440) 668-8364<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"221\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/filemanageit.xyz\/upload\/wp-json\/wp\/v2\/pages\/219\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-221\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/filemanageit.xyz\/upload\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/thecaringcorral.com\/\">BACK TO THE CARING CORRAL HOME PAGE<\/a><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"wider","meta":{"footnotes":""},"class_list":["post-219","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/filemanageit.xyz\/upload\/wp-json\/wp\/v2\/pages\/219","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/filemanageit.xyz\/upload\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/filemanageit.xyz\/upload\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/filemanageit.xyz\/upload\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/filemanageit.xyz\/upload\/wp-json\/wp\/v2\/comments?post=219"}],"version-history":[{"count":8,"href":"https:\/\/filemanageit.xyz\/upload\/wp-json\/wp\/v2\/pages\/219\/revisions"}],"predecessor-version":[{"id":260,"href":"https:\/\/filemanageit.xyz\/upload\/wp-json\/wp\/v2\/pages\/219\/revisions\/260"}],"wp:attachment":[{"href":"https:\/\/filemanageit.xyz\/upload\/wp-json\/wp\/v2\/media?parent=219"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}