Stretch and Soothe Application Form

PLEASE NOTE

Completing your application form does not guarantee that you will be offered a place in the program. We will try to schedule classes to accommodate everyone but this is not always possible. We will be running the program throughout the year and you will be prioritised for a place in future programs if not offered a place in the current round.

Your First & Last Name

Best Contact Number

Your Age

How did you hear about the program?

Your Suburb

Please tell us a little bit about you and why you are seeking support through this type of program. This information is held in strict confidence - we use it only to help us to group people with similar needs and experiences together. You don't need to go into detail, just an overview for example "Domestic Violence", "Grief/Loss", "Childhood Trauma", "Issues with self-worth/self-esteem", "Feeling stuck" etc.*

Are you confident that you can fully commit to attending all sessions in the program? *

Yes No Unsure - but I hope to be able to

Which session/s can you attend?

Only the Friday session Only the Monday session Either session is fine

Do you have any injuries or medical conditions that we need to me aware of to keep you safe?

Yes No

If you answered Yes above, please provide some details.

Payment Options

I need a full scholarship for the program due to financial hardship. (please note that scholarships in this round are only available to ex-ADF members, their partners or their children) I will be paying the term fee of $40 (to be paid in advance - we will email you an invoice)

Please provide the name and contact number for an Emergency Contact person

What relationship to you is your Emergency Contact person?

RELEASE AND WAIVER OF LIABILITY - PERSONAL INJURY: Shianne will do her utmost to ensure you are safe through all the practises. However, you will need to be personally responsible for yourself. This means you need to listen to the feedback your body and mind are giving you. Listening to and honouring your body’s messages will allow the transformation these practices can bring to you to be gradual and permanent. This will be a a personal experience, unique to each person. Try not to be competitive or compare yourself with others. Completely accepting yourself, as you are, will bring the most progress in your practice. If you are feeling pain, it is a sign to soften and do less - approaching the practise more gently. There may be moments of slight discomfort as you move your body in new ways, deepen your breath, and learn the art of concentration, but there should never be any painful sensations.

I understand this waiver and understand that by checking this box and submitting my application, I am agreeing to it.

RELEASE AND WAIVER OF LIABILITY - INTERACTIONS WITH HORSES: Because there are horses at the sanctuary that you may interact with during you visits, we ask that you sign the following waiver. In consideration for being permitted to enter this property and participate in any way in horse activities, I, the undersigned acknowledge and accept that;• Horse activities can be dangerous and horses can act in sudden and unpredictable (changeable) ways, especially if frightened or hurt.• There is significant risk that serious injury or death may result from horse activities. I furthermore confirm I am aware of the obvious risks associated with activities involving horses and I knowingly and freely assume all such risks. I voluntarily participate at my own risk and assume sole responsibility for any injury, death or property damage I may suffer that arises from my participation in horse related activities.I understand and acknowledge the dangers associated with the consumption of alcohol or any mind altering drugs before and during the activity and take full responsibility for any injury, loss or damage associated with their consumption. I agree not to drink alcohol or take drugs prohibited by law before or during this activity.I agree to follow the directions given to me and that any misconduct or refusal by me to follow any direction can result in the CANCELLATION of participation in the activity and my immediate removal from the vicinity of any horse. I understand that any such non-compliance may result in injury, death and/or permanent disability and I agree to indemnify Kanyini Connections Ltd against all claims made by any person as a result of my failure to comply.I agree that I am solely responsible for my actions.I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS AND AGREE NOT TO Kanyini Connections Ltd, their volunteers, program facilitators, agents and/or employees, other participants, land owners, lessors of premises WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or LOSS OR DAMAGE TO PERSON OR PROPERTY.I agree that this waiver will apply immediately and will cover all future visits to the sanctuary. *

I understand this waiver and understand that by checking this box and submitting my application, I am agreeing to it.

RELEASE AND WAIVER OF LIABILITY - COVID-19: I acknowledge and agree that I am not covered by Hoofbeats Sanctuary Insurance in the event I catch COVID-19 whilst visiting the sanctuary. I agree to waive legal claims I may have if I contract COVID-19 while visiting Hoofbeats Sanctuary. I agree that this waiver will apply immediately and will cover all future visits to the sanctuary.

I understand this waiver and understand that by checking this box and submitting my application, I am agreeing to it.