Screening forms for riders will be kept confidential for the duration of the adherence to COVID-19 protocols and will only be viewed by Erin Richey, Elise Hagenow, and/or Angie Boyle. The screening forms will be securely destroyed when Cape Cod Equestrian Center, LLC terminates adhering to any COVID-19 protocol. Individuals can choose not to complete this form. Anyone who chooses not to complete the form will be declined entry into Cape Cod Equestrian Center, LLC, and denied participation in any activity on the property. 

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Please complete this questionnaire prior to your scheduled appointment.


Review Cape Cod Equestrian Center Privacy Policy

Cape Cod Equestrian Center, LLC COVID-19 Guidelines

Staff:

  1. Staff will regularly sanitize common areas and commonly touched surfaces.
  2. Staff will regularly wash and/or sanitize hands.
  3. Any staff showing signs or symptoms of COVID-19 will not be permitted to work.
  4. Staff will practice proper social distancing with students and clients when able to do so safely, and while inside will wear a mask or facial covering for the safety of the student/participant.

Students and Parents:

  1. If you, or anyone in your immediate contact, is showing signs or symptoms of COVID-19, including fever of 99.1 or higher, difficulty breathing, persistent cough, sore throat, or have tested positive for COVID-19 please do not come to the barn for 14 days, or until you are symptom free for 14 days and cleared by your medical provider.
  2. Use of masks or facial coverings is required for Adults and Children 10 years of age and older while inside, and required outside if unable to maintain 6 feet of distance as mandated by the state of Ohio except for those with medical conditions or disability which would prevent them from safely wearing a mask
  3. Once mounted, riders may pull down their mask or remove their mask and hand to a parent, guardian, or chaperone for the duration of their ride, to be put back on once unmounted.
  4. Please limit your use of the facilities to absolute necessity.  If you do need to use the restroom, we ask that you help us by sanitizing after use.
  5. Please respect state social distancing guidelines and stay at least 6 feet from others in attendance at CCEC.
  6. Please only the rider and one chaperone (if necessary) in the barn during your scheduled time. Please, no extra family or siblings.  Please remain at the barn only for the scheduled time of your lesson in order to help minimize the number of people at CCEC at one time.  Keep in mind, as group and social distancing restrictions are lifted these policies will change.
  7. CCEC staff and junior staff members will prepare horses for lessons.  Students may assist in grooming and tacking if they choose. Masks are required while grooming.  Please wash or sanitize your hands prior to and after handling the horses and equipment.
  8. Each student MUST have their own helmet and riding gloves.  
  9. CCEC staff will be sanitizing common areas as often as possible.  Sanitation products are available around the barn and seating areas – You can Help us to keep things clean by sanitizing your chair, hands, door handles, or other objects after use with available products. 

We are eager to get back to our normal daily activities, and appreciate you working with us to be able to keep CCEC a safe and sanitary environment for you and your family as well as our staff.  Please keep in mind these guidelines are in place to help us re-open within Ohio’s guidelines as safely and efficiently as possible.  As state and federal regulations continue to change, this too is a living document and is also subject to change.

 

  • I understand that while I am on the premises of Cape Cod Equestrian Center, LLC, I am required to follow the guidelines that have been provided to me, including, but not limited to: wearing riding gloves; following sanitizing protocol as set forth by the stables, state, and CDC; and practicing social distancing as outlined by the Stables, state, and CDC. Any violation of these guidelines may result in me being restricted from the property of Cape Cod Equestrian Center, LLC. I have read the attached guidelines from Cape Cod Equestrian Center, LLC, and agree to comply fully.
  • I understand that for my/my child’s safety while mounting and for the  duration of my riding time, Cape Cod Equestrian Center, LLC Staff Members and Junior Staff Members/Volunteers may not be able to maintain six feet of distance from me/my child.  I understand the risks involved, and I grant permission to Cape Cod Equestrian Center, LLC, its owners, agents, contractors, or employees to prioritize my/my child’s safety as it pertains to Equine Activities.
  • I hereby waive any liability of Cape Cod Equestrian Center, LLC, its owners, agents, contractors, or employees in the event that I develop symptoms of, or receive a diagnosis of, COVID-19. I understand that I am entering the facilities of Cape Cod Equestrian Center, LLC, located at 3187 E. Centerville Rd, Spring Valley, OH 45370, at my own risk. I attest that all my responses are correct to the best of my knowledge.

In accordance with Ohio public health orders and guidance, Cape Cod Equestrian Center, LLC has followed recommendations to protect its employees and clients from Covid-19 and expects that clients who participate in activities at Cape Cod Equestrian Center, LLC have also complied with all public health orders and guidance in order to minimize the risks associated with Covid- 19. 

I have reviewed and agree to abide by the above the requirements. 

 

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Covid-19 Questionnaire
To the best of your knowledge, have you had close contact with someone with suspected or confirmed COVID-19 infection within the last 14 days?*
No
Yes
Are you currently experiencing, or have you had any of these symptoms in the last 14 days? Fever greater than 99.1F/Difficulty breathing/Persistent cough/Sore throat/General aches or headaches?*
No
Yes
Is anyone in your immediate family/household currently experiencing, or have had any of these symptoms in the last 14 days? Fever greater than 99.1F/Difficulty breathing/Persistent cough/Sore throat/General aches or headaches?*
No
Yes
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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