Volunteer Application

Volunteer Application
Name *

First Name Last Name
Date of Birth *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone Number *

Area Code Phone Number
Cell Phone Number, if different

Area Code Phone Number
Height *
Weight *
Parent/Legal Guardian (if Under 18)

First Name Last Name
Email *
example@example.com
Employer/School *
Preferred Method of Contact *

Phone Text Email
How did you hear about our program? *
Available Start Date *
Volunteer Positions I am interested in *

Leader Side Walker Assistant for Fundraisers and Events Special Skills to share with the program (fill in skills in other option)
Have you volunteered in a therapeutic horsemanship or riding program before? *

Yes No
If yes, please describe what your roles/responsibilities were:
Do you have horses experience, other than therapeutic horsemanship or riding program? *

Yes No
If yes, please drescribe:
Do you have experience working with people with special needs? *

Yes No
If yes, please briefly describe:
Are you able to walk for 45 minutes and jog short distances in sand? *

Yes No
References
List two references. References may be professional or personal but cannot be relatives unless the relatives were also employers.
Name *

First Name Last Name
Relation *
Years Known *
Phone Number *

Area Code Phone Number
Email *
example@example.com
Name *

First Name Last Name
Relation *
Years Known *
Phone Number *

Area Code Phone Number
Email *
example@example.com
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.
Volunteer Signature *

Clear
Date *

Month Day Year
Date
Parent/Legal Guardian Signature (If under 18)

Clear
Date

Month Day Year
Date
Photo Release
*

I DO I DO NOT
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.
Signature (Parent/Legal Guardian if under 18) *

Clear
Date *

Month Day Year
Date
Horseback Riding Agreement and Liability Release Form

For: True Hope Therapeutic Horsemanship
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.
Signature (Parent/Legal Guardian if under 18) *

Clear
Date *

Month Day Year
Date
True Hope Therapeutic Horsemanship

Confidentiality Agreement
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.
Signature *

Clear
Date *

Month Day Year
Date

Authorization for Emergency Medical Treatment

Volunteer
Name *

First Name Last Name
Date of Birth *
Phone Number *

Area Code Phone Number
Physician's Name *
Preferred Medical Facility *
Health Insurance Company *
Policy Number *
Current allergies, medications, and health concerns *
Health Status (particularly as related to physical/emotional demands of working in EAAT. Address fitness, cardiac, respiratory, bone or joint function, recent hospitalizations/surgeries or lifestyle changes. *
In the event of an emergency
Emergency Contact *

First Name Last Name
Relationship *
Home Phone Number *

Area Code Phone Number
Cell Phone Number, if different

Area Code Phone Number
Work Phone Number

Area Code Phone Number
Emergency Contact *

First Name Last Name
Relationship *
Home Phone Number *

Area Code Phone Number
Cell Phone Number, if different

Area Code Phone Number
Work Phone Number

Area Code Phone Number
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.
Type a question *

I DO CONSENT I DO NOT CONSENT
Signature *

Clear
Date *

Month Day Year
Date

Volunteer Handbook Acknowledgement Form
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.
Name *

First Name Last Name
Signature/ Parent Signature (if under 18) *

Clear
Date *

Month Day Year
Date
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Volunteer Application

References

Photo Release

Horseback Riding Agreement and Liability Release Form

True Hope Therapeutic Horsemanship

Authorization for Emergency Medical Treatment

In the event of an emergency

Volunteer Handbook Acknowledgement Form