Volunteer Application

Volunteer Application

Thank you for wanting to join our team! Please fill out the application in full. Dream Catcher will not share your information; all information is kept confidential. We will contact you upon receiving your submission and get you set up with a training / volunteer time.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Gender*
Primary Phone (please tell us if it is a cell or home)*
Email*
example@example.com
Address*

Mailing Address

Street Address

CityState / Province

Postal / Zip Code
Employer or School
Are you (check all that apply)*

MinorAdult with Legal Guardian or CaregiverIndependent AdultVeteran
How did you hear about us?*

Word of MouthSocial MediaOther
If Other Please specify
Are there any special considerations about your volunteering schedule we need to know?
Tee Shirt Size
For minors or adults with legal guardians/ caregivers:
Parent or Guardian Name
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Health History
Please list all medication (including medical marijuana)*
Please note any allergies and if EpiPen or inhaler is used*
What is your general health status? Tell us about any special needs or health concerns:*
Do you have health insurance?

YesNo
Health insurance company name & policy #:
Date*

MonthDayYear
Volunteer Release and Hold Harmless Agreement
Under Oregon Law, an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of participating in equine activities, pursuant to section 30.691, Oregon Revised Statutes.

The program at the StirrUp Hope Therapeutic Riding located at 73292 Wyss Lane, Pendleton, Oregon 97801; provides therapeutic horseback riding for children and adults. Volunteers and horses are carefully selected and trained and safety equipment is required for all riders since horseback riding is a risk exercise.

No student will be accepted for riding instruction and no volunteer accepted for service until this form has been read, understood, completed and signed by the parent(s), caregivers(s) and/or guardian(s) of a minor, or if the student or volunteer is of legal age and sound mind, by the student or volunteer.  Although participation in the program is under strict supervision and every effort is made to avoid injury or accident, the undersigned acknowledges the inherent risks involved in riding and working around horses. This includes, but not limited to, bodily injury from horseback riding or being in close proximity to horses. Among other risks, both horse and rider can be injured in normal use or in competition and schooling. In order to provide this valuable service, no liability can be accepted by the StirrUp Hope Therapeutic Riding located at 73292 Wyss Lane, Pendleton, Oregon 97801, or any of the organizations or persons connected with the above named facility.

I acknowledge the risks and potential for risks in riding and working with horses. However, I feel that the possible benefits to myself/my child/my ward are greater than the risks assumed.

In Consideration, for the privilege of riding and/or working around horses at the StirrUp Hope Therapeutic Riding located at 73292 Wyss Lane, Pendleton, Oregon 97801, the undersigned, as self, or as parent(s) or guardian(s) of the undersigned minor, jointly and severally, do hereby agree to release, hold harmless and indemnify the StirrUp Hope Therapeutic Riding, its officers, directors, trustees, agents, employees, representatives, property owners, successors and assigns, from all manner of liability, loss, costs, claims, demands and damages of every kind and nature whatsoever, including but not limited to reasonable attorney’s fees, which the undersigned or said minor may now or in the future have against the StirrUp Hope Therapeutic Riding, its officers, directors, trustees, agents, employees, representatives, property owners, successors and assigns, on account of any accident, damage, injury or illness, physical or mental condition, known or unknown, to the undersigned or said minor, or the treatment thereof, arising as a result of, or in any way connected to acts or incidents occurring at or relating to the StirrUp Hope Therapeutic Riding, its officers, directors, trustees, agents, employees, representatives, property owners, successors or assigns, including but not limited to their negligence or gross negligence in rendering the services described above or in any way incidental thereto.
I accept and agree to the terms and conditions listed above*

Agree
Electronic Signature of Volunteer or Parent/ Guardian if Volunteer is a minor*
Signature*

Clear
Date*

MonthDayYear
EMERGENCY MEDICAL TREATMENT policy for StirrUp Hope TR
Under Oregon Law, an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of participating in equine activities, pursuant to section 30.691, Oregon Revised Statutes.

The program at the StirrUp Hope Therapeutic Riding located at 73292 Wyss Lane, Pendleton, Oregon 97801; provides therapeutic horseback riding for children and adults. Volunteers and horses are carefully selected and trained and safety equipment is required for all riders since horseback riding is a risk exercise.

No student will be accepted for riding instruction and no volunteer accepted for service until this form has been read, understood, completed and signed by the parent(s), caregivers(s) and/or guardian(s) of a minor, or if the student or volunteer is of legal age and sound mind, by the student or volunteer.  Although participation in the program is under strict supervision and every effort is made to avoid injury or accident, the undersigned acknowledges the inherent risks involved in riding and working around horses. This includes, but not limited to, bodily injury from horseback riding or being in close proximity to horses. Among other risks, both horse and rider can be injured in normal use or in competition and schooling. In order to provide this valuable service, no liability can be accepted by the StirrUp Hope Therapeutic Riding located at 73292 Wyss Lane, Pendleton, Oregon 97801, or any of the organizations or persons connected with the above named facility.

I acknowledge the risks and potential for risks in riding and working with horses. However, I feel that the possible benefits to myself/my child/my ward are greater than the risks assumed.

In Consideration, for the privilege of riding and/or working around horses at the StirrUp Hope Therapeutic Riding located at 73292 Wyss Lane, Pendleton, Oregon 97801, the undersigned, as self, or as parent(s) or guardian(s) of the undersigned minor, jointly and severally, do hereby agree to release, hold harmless and indemnify the StirrUp Hope Therapeutic Riding, its officers, directors, trustees, agents, employees, representatives, property owners, successors and assigns, from all manner of liability, loss, costs, claims, demands and damages of every kind and nature whatsoever, including but not limited to reasonable attorney’s fees, which the undersigned or said minor may now or in the future have against the StirrUp Hope Therapeutic Riding, its officers, directors, trustees, agents, employees, representatives, property owners, successors and assigns, on account of any accident, damage, injury or illness, physical or mental condition, known or unknown, to the undersigned or said minor, or the treatment thereof, arising as a result of, or in any way connected to acts or incidents occurring at or relating to the StirrUp Hope Therapeutic Riding, its officers, directors, trustees, agents, employees, representatives, property owners, successors or assigns, including but not limited to their negligence or gross negligence in rendering the services described above or in any way incidental thereto.
Emergency Contact 1*
Phone Number*
Please enter a valid phone number.
Relationship to Volunteer*
Photo & Publicity Release
I DO/ I DO NOT Consent to and authorize the use and reproduction by Dream Catcher Therapeutic Riding Center of any and all photographs and any other audio/visual materials taken of me for promotional material, educational activities, exhibitions or for any other use for the benefit of the program.
Photo Consent Check One*

I DOI DO NOT
Volunteer Signature OR Parent/ Guardian Electronic Signature if volunteer is a minor*

Clear
Volunteer Jobs
Volunteers are the heart and soul of our programs and critical to the success of our mission. Dream Catcher TRC is able to provide therapeutic horseback riding because of the donations of time and talent of specially trained community volunteers. There are a wide variety of volunteer jobs available at Dream Catcher TRC, the most important being the "sidewalker" and "leader" positions that support our participants in their lessons.

SIDEWALKER: Works with our participants in the arena. A Sidewalker’s job is to empower the participant in all phases of the lesson. Sidewalkers interact with and guide the client, and also serve as an extra set of eyes and ears for the instructor. Sidewalkers are responsible for the participant’s safety, comfort, learning, and interaction with the horse.

LEADER: Works with the horse during the lesson. A Leader’s job is to halter the horse and bring to grooming area before the lesson, help with grooming and tacking, and handle the horse during all phases of the lesson. Leaders are primarily responsible for addressing the comfort and safety of the horse, and will interact with and observe the horse at all times to ensure the safety of the participant.*No experience is necessary to begin helping as a lesson volunteer at Dream Catcher TRC. We provide all the training necessary for you to be successful at the barn. All trained volunteers are automatically eligible to work as sidewalkers helping participants in the arena. **Volunteers who wish to become leaders must show competency in handling equines and must participate in a specialized leader training.
What type of Volunteering Interests you? (mark all that apply)*

Helping participants in the arenaFacility/ Barn WorkAdministrative assistanceSpecial event help/ fundraisersWork from home projects
Do you have any previous horse experience?*

YesNoI don't have previous experience but I would like to learn more about horses
If you answered yes, please explain.
Do you have any special talents or skills in the following areas?

Marketing, advertising, promotions, and social mediaSpecial event planning, auction planning, procurementFencing, electrical and building repairs or maintenanceData entry
Do you have any other special talents of skills you would like to tell us about?
Do you have any experience working with individuals with special challenges?*

YesNo
If you checked "Yes" please explain:
Previous volunteer experience if any?
Confidentiality Agreement
Dream Catcher Therapeutic Riding Center shall preserve the right of confidentiality for all individuals in its program.
1.The staff shall keep confidential all medical, social, referral, personal and financial information regarding a person and his/her family.
2.The staff will not disclose information to outside agencies or individuals without specific written consent of the rider or parent/guardian.
3.The volunteer will keep confidential all information about rider, family, parent/guardian. In the case of a breach of this confidentiality the volunteer will be reprimanded. If this occurs again, the volunteer will be terminated.
I accept and agree to the terms and conditions listed above.*

Agree
Signature*

Clear
Date*

MonthDayYear
Dream Catcher Background Check
Pre-Employment or Volunteer Authorization Form***Not required for volunteers under the age of 18. The undersigned authorizes Dream Catcher TRC to obtain and receive information from any law enforcement agency, including police departments and sheriff's departments of this state or any other state or federal government, to the extent permitted by state and federal law, pertaining to any convictions I may have had for violations of state or federal criminal laws, including but not limited to convictions for crimes committed upon children.

I understand that such access is for the purpose of considering my application as an employee/ volunteer, and that I expressly DO NOT autnorize DREAM CATCHER THERAPEUTIC RIDING CENTER, its directors, officers, employees or other volunteers to disseminate this information in any way to any other individual, group, agency, organization, or corporation.
List other Names Previously used (including maiden name):
Driver License/ Identity Card Number and State Issued:
1. Have you ever been convicted of a sex- related crime?

YesNo
2. Have you ever been convicted of animal cruelty or neglect?

YesNo
3. Have you been convicted of a crime involving violence or threat of violence in the last 10 years?

YesNo
4. Have you been convicted of a crime involving drugs or alcohol in the last 10 years?

YesNo
5. Have you been convicted of a crime except a minor traffic violation in the last 10 years?

YesNo
6. Have you been arrested for a crime for which there has not yet been an acquittal or dismissal?

YesNo
7. Please list all the states you have resided during the last 10 years.
I hereby grant Dream Catcher TRC permission to check civil and/ or criminal records to verify any statements made on this form.

I Agree
Regardless of weather the applicant grants consent, Dream Catcher TRC will conduct a criminal offender record check on the applicant. Discrimination by an employer on the basis of arrest records alone my violate federal civil rights laws. The applicant may obtain further information concerning the applicant's rights by contacting the Bureau of Labor and Industries, Civil Rights Division, State Office Building, Suite 1070, Portland, OR 97232, telephone (503) 731-4075.

I acknowledge receipt of this notice
I hereby grant Dream Catcher TRC permission to check civil and/ or criminal records to verify any statements made on this form.

Agree
Volunteer Signature:

Clear
Date

MonthDayYear
TRAIN Crossing Safety & Driveway Rules

To access the property, we must safely cross a private rail crossing.
According to Oregon LAW:

1. Stop, look both ways, and listen. Know that trains always have the right of way.
Don’t stop on the tracks. Make sure you have room to get across. Once you enter the crossing, keep moving.

2. Stop 15 feet away from the stop sign.

3. Never try to "drive faster" than the train. If you can see it - wait. (They travel faster than you realize).

4. Never assume that there is only one train coming from a single direction. (Generally in the middle of the day there are a few trains that come and go).

5. If your car stalls on a track, quickly get everyone out — even if you don’t see a train coming. Run away from the tracks and your car to avoid being hit by flying debris and CALL 911.

6. Morgan's LAW- If you see the train, don't drop off your individual and have them cross by foot & NEVER climb over a stopped train.

** Please drive slowly on the road before the train tracks to respect the neighbors and property owners. After crossing, please drive no more than 5mph to be considerate to the property owner- watch for dogs and other vehicles as you pass the garage.

** If these rules are violated- we may have to discuss termination of services.
I have read and agree *
Initial PLEASE
Should be Empty:

Volunteer Application

For minors or adults with legal guardians/ caregivers:

Health History

Volunteer Release and Hold Harmless Agreement

EMERGENCY MEDICAL TREATMENT policy for StirrUp Hope TR

Photo & Publicity Release

Volunteer Jobs

Confidentiality Agreement

Dream Catcher Background Check

TRAIN Crossing Safety & Driveway Rules