VOLUNTEER APPLICATION

VOLUNTEER APPLICATION
Rhythms of Grace 23625 River Heights Dr. Dallas Center, IA 50063
Volunteer Info Name

First NameLast Name
Link to Volunteer Contact Record

First NameLast Name
Phone
Email
example@example.com
Date of Birth

MonthDayYear
Date
Parent or Guardian if under 18

First NameLast Name
Parent or Guardian Phone if under 18
Status
How did you hear about us?

FriendSocial MediaOnline Volunteer ServiceRecruiting EventOther
Areas of Interest

Admin HelpBarn Buddy (Mucking)Barn LeaderBecoming PATH InstructorBoard of DirectorsEvent & Auction SoftwareFacilities MaintenanceFundraisingGarden AngelsGrant WritingHorse GroomerLesson Horse LeaderLesson ScribeLesson Side WalkerNewsletterPhotographyPublic RelationsVolunteer Recruitment
Previous Horse Experience?

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School or Work
Previous Experience with Special Needs?

YesNo
Session(s) Available

SpringSummer 1Summer 2Fall
Days & Times Available

Tuesday MorningTuesday AfternoonTuesday EveningWednesday MorningWednesday AfternoonWednesday EveningThursday MorningThursday AfternoonThursday Evening
Professional Expertise
T-Shirt Size
MEDICAL INFORMATION
Emergency Contact
Emergency Contact Number
Emergency Contact Alt. Phone
Please enter a valid phone number.
Physical Limitations
Physician
Physician Number
Health Insurance Co.
Policy #
Hospital Preference
Allergies
REFERENCES PLEASE LIST TWO (NON-FAMILY REFERENCES)
Reference 1 Name

First NameLast Name
Reference 1 Email
example@example.com
Reference 1 Cell Phone
Reference 2 Name

First NameLast Name
Reference 2 Email
example@example.com
Reference 2 Cell Phone
CONSENT FOR EMERGENCY TREATMENT
I am over 18 years of age and fully competent to sign this Emergency Medical Form, which I have read and understand, or, if under age, I have obtained the signature of my parent/guardian, who, by such signature, represents he/she has read and understands this form. In case of medical emergency or necessity, I, the volunteer, authorize Rhythms of Grace to seek or provide for such medical assistance as may be necessary or advisable and further authorizes Rhythms of Grace to seek the assistance of any physician or medical facility to provide any medical/surgical care, including, but not limited to, hospitalization, with such treatment to include anesthesia as necessary or advisable, that the physician or medical facility deems or determines to be necessary or advisable, pending receipt by the physician or medical facility of any other consent to treatment from or on behalf of myself, the volunteer. I understand that NO LIABILITY can be accepted by any of the organizations concerned, including Rhythms of Grace, in the event an accident may occur. In the event any provision of this form is determined to be unenforceable, all other provisions shall remain in full force and effect.
Consent for Emergency Treatment

MonthDayYear
Date Signed
Volunteer Applicant signature*

Clear
Emergency Medical Form Signature of Parent/Guardian (if under 18)

Clear
LIABILITY RELEASE

Statement of Understanding, Authorization Release and Indemnity
I, the undersigned ("Volunteer"), am over 18 years of age and fully competent to make this Statement of Understanding, Authorization, Release and Indemnity ("Statement"), which I have read and understand.I understand the information I have provided may be verified and permit Rhythms of Grace to inquire of others concerning my suitability as a volunteer. In the course of volunteering, I may deal with confidential information and agree to keep said information in the strictest confidence. The relationship between Rhythms of Grace and me is an "at will" arrangement and may be terminated at any time, without cause, by either Rhythms of Grace or me. I understand that, as a volunteer, I will assist in the riding and instruction of mentally or physically challenged riders, and that I will work with and around horses, as well as riders. I understand that I cannot serve as a volunteer until this Statement has been signed.

In return for the opportunity to serve as a volunteer with Rhythms of Grace, I hereby forever release, acquit and discharge Rhythms of Grace and its officers, directors, trustees, agents, employees, representatives, affiliates, successors and assigns (collectively the "Released and Indemnified Parties") from any and all claims, demands and causes of action of any and every kind or nature, including those caused in whole or in part by the negligence of any of the Released and Indemnified Parties, which I may now or in the future have against any or all of the Released and Indemnified Parties and that arise in whole or in part as a result of my involvement with Rhythms of Grace. I also understand and agree that Rhythms of Grace assumes no liability for accidents or acts of negligence or gross negligence by anyone, including the Releases and Indemnified Parties.

I further agree to fully indemnify and defend any of the Released and Indemnified Parties against any and all claims, demands or causes of action of any and every kind or nature (including attorney's fees and other defense costs), including those caused in whole or in part by the negligence of any or all of the Released and Indemnified Parties, which directly or indirectly relate to personal injuries or property damages sustained by me and that arise in whole or in part as a result of my involvement with Rhythms of Grace. If any provision of this Statement is determined to be unenforceable, all other provisions shall remain in full force and effect.
Liability Release

MonthDayYear
Date Signed
Volunteer State of Understanding Signature*

Clear
I represent to Rhythms of Grace that I am the parent or guardian of the Volunteer whose signature appears above. On behalf of that Volunteer, I agree and accept all of the provisions of the foregoing Statement of Understanding, Authorization, Release and Indemnity. I am authorized to sign this Statement on behalf of the Volunteer and my doing so legally binds the Volunteer as if he/she were not a minor.
Statement of Understanding Signature of Parent/Guardian (if under 18)

Clear
PHOTO RELEASE

Consent for Photography/Videography
For valuable consideration given and which is hereby acknowledged, the Volunteer named above hereby grants to Rhythms of Grace permission to take, or have taken, still and moving photographs and films, including television pictures, of the Volunteer, and consents and authorizes Rhythms of Grace, its advertising agencies, news media, and any other persons interested in Rhythms of Grace and its work, to use and reproduce such photographs, films or pictures, and to circulate and publicize the same by all means, including, without limiting the generality of the foregoing, newspapers, television media, brochures, pamphlets, instructional materials, books, and clinical materials. With respect to the foregoing matters, no inducements or promises have been made to secure this signature to this release other than the intention of Rhythms of Grace to use, or cause to be used, such photographs, films, and pictures for the primary purpose of promoting Rhythms of Grace and its work.

Please check one of the boxes to indicate your consent or non-consent of photo release:
Photo Release
Consent Photo/Video Release Volunteer Signature*

Clear
I represent to Rhythms of Grace that I am the parent or guardian of the Volunteer whose signature appears above. On behalf of the Volunteer, I agree to and accept all of the provisions of the foregoing Consent for Photography (Photo Release I am authorized to sign this Statement on behalf of the Volunteer and my doing so legally binds the Volunteer as if he or she were not a minor.
Photo/Video Consent Signature of Parent/Guardian (if under 18)

Clear
CONFIDENTIALITY RELEASE
The undersigned volunteer of Rhythms of Grace acknowledges that while volunteering, Volunteer may receive and have access to information and records of Rhythms of Grace clients, volunteers, and donors including but not limited to medical records, diagnosis, progress reports, and financial statements.

The volunteer hereby agrees to hold such information in confidence and not to divulge the information to any person except as directed by Rhythms of Grace. Volunteers also further agree that written materials in the client, volunteer or donor's files will be maintained in confidence and not removed from such files.
Confidentiality Release

MonthDayYear
Date Signed
Confidentiality Agreement Volunteer Signature*

Clear
SOCIAL MARKETING POLICY
In the area of social media (print, broadcast, digital, online), the following guidelines apply in the use of social media for our volunteers:

1.Should you decide to create a personal blog or website, be sure to provide a clear disclaimer that the views expressed in the blog are the author's alone and do not represent the views of Rhythms of Grace.

2.All information published on any volunteer blog should comply with Rhythms of Grace's confidentiality policy. This also applies to comments posted on other social networking sites, blogs and forums.

3.Your online presence can reflect on Rhythms of Grace. Be aware that your comments, posts or actions captured via digital, or film images can affect the image of Rhythms of Grace.

4. Do not use any Rhythms of Grace logos or trademarks without written consent.

5.I hereby confirm that I have read and understand the Social Media policy of Rhythms of Grace.
Social Marketing Policy

MonthDayYear
Date Signed
Social Media Policy Volunteer Signature*

Clear
CONSENT FOR BACKGROUND CHECK
AUTHORIZATION, WAIVER and INDEMNITY I,the Volunteer Applicant named above, hereby give my permission for Rhythms of Grace to obtain information relating to my criminal history record. The criminal history record, as received from the reporting agencies, may include arrest and conviction data, as well as plea bargains and deferred adjudications. I understand that this information will be used, in part, to determine my eligibility for employment or a volunteer position with Rhythms of Grace. I also understand that, if I remain an employee or a volunteer with Rhythms of Grace, the criminal history records check may be repeated at any time. I understand that I will have an opportunity to review the criminal history report and a procedure is available for clarification if I dispute the record as received. I, the Applicant named above, do, for myself, my heirs, executors, and administrators, hereby remise, release, and forever discharge and agree to indemnify and hold harmless Rhythms of Grace and each of their officers, directors, employees, and agents from and against any and all causes of action, suits, liabilities, costs, debts and sums of money, claims and demands whosoever, and any and all related attorneys' fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to become an employee of, or volunteer for, Rhythms of Grace.

I agree to log in, complete and pay for the OneSource Background Check.
Consent for Background Check

MonthDayYear
Date Signed
Applicant signature*

Clear
THANK YOU FOR COMPLETING YOUR APPLICATION.
ADDITIONAL ITEMS REQUIRED
Before Volunteering in Lesson/Therapy

See https://rhythmsofgraceequine.org/volunteer

COMPLETE ONESOURCE BACKGROUND CHECK (AGE 18 AND OVER)

COMPLETE IN-PERSON ORIENTATION/TRAINING

REVIEW WRITTEN HANDBOOK ONLINE

REVIEW LESSON VOLUNTEER VIDEO ONLINE
Should be Empty:

VOLUNTEER APPLICATION

MEDICAL INFORMATION

CONSENT FOR EMERGENCY TREATMENT

LIABILITY RELEASE

PHOTO RELEASE

CONFIDENTIALITY RELEASE

SOCIAL MARKETING POLICY

CONSENT FOR BACKGROUND CHECK

ADDITIONAL ITEMS REQUIRED