List two references.  References may be professional or personal but cannot be relatives unless the relatives were also employers.

I certify that this volunteer is physically fit, have sufficently trained for participation in Riding, and have not been advised otherwise by a qualified medical person.  This volunteer attests that I do not have any conditions or limitations that would prevent me from participating in riding and other equine activities.  

I certify that answers given herein are true and complete to the best of my knowledge.  I authorise investigation of all statements contained within this volunteer application for True Hope Therapeutic Horsemanahip.  I understand and agree that false and misleading information given in my application may result in the immediate discharge from volunteering at True Hope Therapeutic Horsemanship.

Consent to and authorize the use and reproduction by True Hope Therapeutic Horsemanship of any and all photographs and any other audio/visual materials taken of participants and/or myself for promotional material, educational activities, exhibitions or for any other use for the benefit of the program.

This form must be completed for each volunteer.

PLEASE READ CAREFULLY BEFORE SIGNING:

Under New Hampshire law, an equine activity sponsor or professional shall not be liable for any injury to, or the death of a participant in equine activities resulting from the inherent risk of equine activities (New Hampshire Stat. 508:19).

I acknowledge that riding a horse is an inherently dangerous activity and carries with it the potential for death, serious injury, and property loss. “Horse” as used herein shall refer to all equine species. “Horseback Riding” or “Riding” shall refer to riding or otherwise handling of horses, ponies, mules, or donkeys, whether from the ground or mounted. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of animals, equipment, vehicular traffic, actions of other people including, but not limited to, participants, spectators, volunteers, and/or instructors or coaches. These risks are not only inherent to participants but are also present for others present during Riding. I therefore realize that participation in Riding includes but is not limited to participating in any True Hope program or event, volunteering, and observing. I hereby assume all of the risks of participating in the Horseback Riding. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from their horses, volunteers, or employees, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently trained for participation in Riding, and have not been advised otherwise by a qualified medical person. I attest that I do not have any condition or limitation that would prevent me from participating in Riding. It is the responsibility of the participant to carry full and complete insurance coverage on his/her horse, personal property, and him/herself.

I acknowledge that this Accident Waiver and Release of Liability form will be used by the owners of the horses, owners of the real estate, owners of the facility, or others employed by such parties, and that it will govern my actions and responsibilities at each Riding occasion.

In consideration of my application and permitting me to participate in Horseback Riding, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me, including my traveling to and from the Riding facility, THE FOLLOWING ENTITIES OR PERSONS:

True Hope Therapeutic Horsemanship

and any and all directors, officers, employees, volunteers, representatives, and agents, and/or sponsors of the above; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in Riding, whether caused by the negligence of releasees or otherwise.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness.

The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I hereby certify that I have read this document and I understand its content.

I acknowledge that riding a horse is an inherently dangerous activity and carries with it the potential for death, serious injury, and property loss. “Horse” as used herein shall refer to all equine species.  “Horseback Riding” or “Riding” shall refer to riding or otherwise handling of horses, ponies, mules, or donkeys, whether from the ground or mounted.  The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of animals, equipment, vehicular traffic, actions of other people including, but not limited to, participants, spectators, and/or coaches. These risks are not only inherent to participants but are also present for others present during Riding.

I hereby assume all of the risks of participating in the Horseback Riding. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from their horses or employees, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

New Hampshire Bill 793 508:19

I certify that I am physically fit, have sufficiently trained for participation in Riding, and have not been advised otherwise by a qualified medical person.

I acknowledge that this Accident Waiver and Release of Liability form will be used by the owners of the horses, owners of the real estate, owners of the facility, or others employed by such parties, and that it will govern my actions and responsibilities at each Riding occasion.

In consideration of my application and permitting me to participate in Horseback Riding, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: 

(A) Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me, including my traveling to and from the Riding facility, THE FOLLOWING ENTITIES OR PERSONS:

Renee Pecor and Mike Southwell

and their directors, officers, employees, volunteers, representatives, and agents, and/or sponsors; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in Riding, whether caused by the negligence of releasees or otherwise.  

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness.

I understand that Horseback Riding or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by any of the releasees.

The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I hereby certify that I have read this document and I understand its content. 

Confidentiality Policy

All information concerning participants, former participants, staff, volunteers, and financial data, and business records of True Hope Therapeutic Horsemanship is confidential. “Confidential” means that you are free to talk about True Hope Therapeutic Horsemanship and about the program and your position, but you are not permitted to disclose clients’ names or talk about them in ways that will make their identity known. No information may be released without appropriate authorization.

All records dealing with specific participants must be treated as confidential. General information, policy statements or statistical material that is not identified with any individual or family is not classified as confidential. Staff members and volunteers are responsible for maintaining the confidentiality of information relating to other staff members and volunteers, in addition to participants. Failure to maintain confidentiality may result in termination of your employment or volunteer position.

Certification

I have read True Hope Therapeutic Horsemanship’s policy on confidentiality and the Confidentiality Policy presented above. I agree to abide by the requirements of the policy and inform the Volunteer Coordinator, Instructor or Director immediately if I believe any violation (unintentional or otherwise) of the policy has occurred. I understand that violation of this policy will lead to disciplinary action, up to and including termination of my service with True Hope Therapeutic Horsemanship.

In the event that emergency medical aid/treatment is required due to illness or injury during the process of reciving services, volunteering, or while being on the property of the agency, I authorise True Hope Therapeutic Horsemanship to:

1. Secure and retain medical treatment and transportation, if needed.
2. Release client records upon request to the authorized individual or agency involved in the medical emergency treatment.  

CONSENT PLAN

This authorization includes x-rays, surgery, hospitalization, medication, and any treatment procedure deemed "life-saving" by the physician.  This provision will only be invoked if the person(s) listed above cannot be reached.

I have fully read the True Hope Therapeutic Horsemanship Volunteer Handbook.  I understand and agree to abide by the guidelines set forth in this handbook.  I understand failure to follow rules and policies may result in a termination of your volunteer privileges. 

I acknowledge that equine activities are an inherently dangerous activity and carries with it the potential for serious injury.  I hereby knowingly and voluntarily assume such risk and I further acknowledge and understand that the behavior and temperament of horses is unpredictable.