Family Volunteer Form

Family Volunteer Form

Please use this form to volunteer as a family. All family members must reside at the same address listed on this form or you must complete an individual volunteer form. This form is comprehensive, including all of our rules and liability forms. It should take between 10-15 minutes to complete.
Date

MonthDayYear
Date
Name Parent/Legal Guardian 1*

First NameLast Name
Date of Birth Parent/Legal Guardian 1*

MonthDayYear
Date
Name Parent/Legal Guardian 2

First NameLast Name
Date of Birth Parent/Legal Guardian 2

MonthDayYear
Date
Name Child 1

First NameLast Name
Date of Birth Child 1

MonthDayYear
Date
Age Child 1
Name Child 2

First NameLast Name
Date of Birth Child 2

MonthDayYear
Date
Age Child 2
Name Child 3

First NameLast Name
Date of Birth Child 3

MonthDayYear
Date
Age Child 3
Name Child 4

First NameLast Name
Date of Birth Child 4

MonthDayYear
Date
Age Child 4

Address of Family*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number Parent/Legal Guardian 1*
Please enter a valid phone number.
Phone Number Parent/Legal Guardian 2
Please enter a valid phone number.
Email*
example@example.com
Occupation Parent/Legal Guardian 1
Occupation Parent/Legal Guadian 2
Reference Name

First NameLast Name
Reference Phone Number
Please enter a valid phone number.
Do you or anyone listed above have any history of committing physical violence?*

YesNo
If yes, please explain
Do you or anyone listed above have any history of criminal convictions?*

YesNo
If yes, please explain

CLIENT/PARTICIANT LIABILITY RELEASE

In consideration of my/my child’s/my ward’s participation in any equine or other day camp or volunteer-related activities at Horses for Hope TRC, Inc., hereafter known as “HfH”, I hereby release and waive my rights to sue HfH, the Staff or Board of Directors of HfH, HfH affiliates/vendors/contractors, Equine owners, and the owner of the farm property, for any loss, damage, injury or death to person or property sustained by me/my child/my ward in equine or other activities by any cause whatsoever including risks inherent in equine or other activities, such as, but not limited to, (1) the propensity for equines to behave in dangerous ways which may result in injury or death to a participant or bystander, or damage to property; (2) the inability to predict an equine’s reaction to sound, movements, objects, persons, or animals; and (3) the hazards of surface or subsurface conditions, whether known or unknown, of the farm, arena, playground, or barn environment. I assume all of the foregoing risks inherent in equine and other activities and accept complete responsibility relating to those risks and any other potential risks of horseback riding, recreational equine activities, horse shows, camp, working with horses, maintenance, or volunteer activities. I feel that the possible benefits to me/my child/my ward are greater than the risk assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against HfH, its staff and Board of Directors, Instructors, Therapists, Aides, Volunteers, Employees, horse owners and the owner of the farm property, from and against, any and all loss, damage, injury, or death, to person or property, by whatever cause, including any act of omission. I agree to indemnify HfH, and the owner of the farm property against all claims, demands, suits, and expenses arising out of any injury to any person or damage to any property caused by my animals, attendants, or myself/my children/my wards. This waiver shall be valid until expressly revoked in writing by a legally appointed guardian or myself.

(Parents/legal guardians must sign for children under 18 or wards of the court. Both parents/guardians must sign if there is joint or shared custody.)
Signature Parent/Legal Guardian 1*

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Name Parent/Legal Guardian 1

First NameLast Name
Date

MonthDayYear
Date
Signature Parent/Legal Guardian 2

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Signature Parent/Legal Guardian 2

First NameLast Name
Date

MonthDayYear
Date
Photo Release*

I consent to and authorizeI DO NOT consent and authorize
Consent Signature Parent/Legal Guardian 1

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Name Parent/Legal Guardian 1

First NameLast Name
Date

MonthDayYear
Date
Consent Signature Parent/Legal Guardian 2

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Name Parent/Legal Guardian 2

First NameLast Name
Date

MonthDayYear
Date
Non-Consent Signature Parent/Legal Guardian 1

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Name Parent/Legal Guardian 1

First NameLast Name
Date

MonthDayYear
Date
Non-Consent Signature Parent/Legal Guardian 2

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Name Signature Parent/Legal Guardian 2

First NameLast Name
Date

MonthDayYear
Date
POLICY OF CONFIDENTIALITY:

Confidentiality is defined as “told in secret or private relations; trusted.” Any information in regards to the participants (clients) at Horses for Hope must be held in strict confidentiality. It is critical that we respect each individual. Confidentiality is considered one of the most basic responsibilities of our facility. Failure to abide by this policy may diminish the quality of the services we provide and result in legal ramifications. I have read and understand Horses for Hope’s Policy of Confidentiality and agree to abide by same.

(If any volunteer is under 18 years of age, both parent signatures are required)
Signature Parent/Legal Guardian 1*

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Name Parent/Legal Guardian 1

First NameLast Name
Date

MonthDayYear
Date
Signature Parent/Legal Guardian 2

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Name Parent/Legal Guardian 2

First NameLast Name
Date

MonthDayYear
Date
*** Horses for Hope abides by Federal regulations mandating no tolerance for sexual or other illegal harassment ***

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT FORM (FAMILY)

(All family members listed on this form MUST be covered under the same insurance policy – otherwise complete an indivifual form)
Preferred Medical Facility
Physician's Name for Parent/Legal Guardian 1
Physician's Name for Parent/Legal Guardian 2
Physician's Name for Children
Health Insurance Company
Policy #
Member ID:
Emergency Contact 1*

First NameLast Name
Relationship to Emergency Contact 1*
Phone Number for Emergency Contact 1*
Please enter a valid phone number.
Emergency Contact 2*

First NameLast Name
Relationship to Emergency Contact 2*
Phone Number for Emergency Contact 2*
Please enter a valid phone number.
Allergies and who is affected:
Current Medications we should be aware of and who takes them:
AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, volunteering, or while being on the property of the agency, I hereby authorize Horses for Hope to:

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

CONSENT PLAN:
This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed “life-saving” by the physician. This provision will only be invoked if the person below is unable to be reached.

NON-CONSENT PLAN:
I do not give my consent for emergency medical treatment/aid in the case of illness or injury during the process of receiving services, volunteering, or while being on the property of the agency. In the event emergency aid/treatment is required, I wish the following procedures to take place (If you choose this plan, you must fill in some specifics for the aid which you will/will not allow.)
Consent/Non-Consent*

I ConsentI DO NOT Consent
In the event emergency aid/treatment is required, I wish the following procedures to take place:
Consent Signature Parent/Legal Guardian 1

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Name Parent/Legal Guardian 1

First NameLast Name
Date

MonthDayYear
Date
Consent Signature Parent/Legal Guardian 2

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Name Parent/Legal Guardian 2

First NameLast Name
Date

MonthDayYear
Date
Non-Consent Signature Parent/Legal Guardian 1

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Name Parent/Legal Guardian 1

First NameLast Name
Date

MonthDayYear
Date
Non-Consent Signature Parent/Legal Guardian 2

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Name Parent/Legal Guardian 2

First NameLast Name
Date

MonthDayYear
Date

HORSE RELATED ACTIVITIES COME WITH THIS WARNING

SECTION A. Protective Attire

1. I am hereby advised to always wear hard-soled, fully enclosed shoes or boots and socks to protect feet and long pants to protect legs while working around or interacting with horses.

SECTION B. The Nature and Physical Character of the Horse Domesticated, well-trained horses are usually obedient, docile and affectionate. However, it is important to understand that their survival instincts are what have allowed the horse to survive from prehistoric times to the present day.

1. I am advised that horses are unpredictable by nature, with minds of their own, as are all animals both domestic and wild. The horse is often somewhat high strung or nervous by nature. Horses are extremely strong and physically powerful. Horses are extremely heavy weighing from 600 to 1300 pounds on the average. These characteristics deserve a human being’s utmost respect.

2. I am advised that when a horse is frightened, angry, under stress or feels threatened, it is the horse’s instinct to jump forward or sideways, to run away from danger at a trot or gallop of speeds up to 35
miles per hour.

3. I am advised that if a horse is frightened or feels threatened from behind, the horse may kick straight back, sideways in either direction or even forward with either or both hind legs with tremendous force.

4. I am advised that if a horse is frightened or feels threatened from above or from his/her back, he/she may hunch the back and buck in a way that could throw a rider to the ground with tremendous force. A fall from a horse will usually be from a height of 3 to 6 feet.

5. I am advised that if a horse is frightened or feels threatened from the front, the natural reaction may be to rear up with both front legs, strike with one or both front legs, bite with teeth, throw the head up or from side to side, or run directly over whatever he/she fears in front of him/her.

6. I am advised that a human must always approach a horse calmly and quietly with caution, preferably to the horse’s shoulder or lower neck, talking soothingly to the horse.

7. I am advised that loud and/or sudden unexpected movements, dropping of objects near a horse, approaching vehicles or animals or people, ill- fitting equipment or physical pain can provoke a domesticated horse to react according to natural, protective instincts.

8. I am advised that the first signs of anger or fear in a horse are the sudden tensing of the muscles of the body, possibly laying the ears flat back against the head, or quickly tossing or raising the head, or sudden snorting through the nostrils accompanying at least one other warning sign.

9. I am advised that a horse can see independently with each eye, actually looking in one direction with one eye and another direction with the other eye. The horse can also focus both eyes on one object somewhere in front of him/her. Typically the direction the ear is pointing will tell an observer where the eye is looking on the same side.

10. I am advised that a horse has two blind areas around which he/she cannot see. Those areas are directly behind the horse and directly in front. When a horse has his/her head lowered to the ground, the spot directly at the end of the nostrils is a blind area. This is the reason it is best to approach a horse close to the shoulder, and never to surprise a horse from the rear, or to reach first for the horse’s mouth.

11. I am advised that while a horse is very sure-footed by nature, horses may accidentally step on an object such as a human’s foot when the horse is balancing or turning around. When a horse is worked on unstable ground or slippery grass or footing, the horse could fall down injuring the horse, rider and /or handler.

“WARNING - Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina General Statutes.”

I have read and do understand the above warnings concerning protective attire and the nature and physical character of the horse.
Signature Parent/Legal Guardian 1*

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Name Parent/Legal Guardian 1

First NameLast Name
Signature Parent/Legal Guardian 2

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Name Parent/Legal Guardian 2

First NameLast Name
Signature Child 1

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Signature Child 2

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Signature Child 3

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Signature Child 4

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Rules

Horses for Hope, (HfH), is a multiuse, family-friendly equestrian center. Safety is paramount. With this in mind, all participants, volunteers, staff and visitors will adhere to the following rules and guidelines:

1. NO OPEN SHOES ALLOWED – No one is allowed through the gate of the parking lot with open-toed shoes, open-heeled shoes, or hole(s) of any kind in the shoes – this applies to EVERYONE, including riders, siblings, parents, visitors, etc., so please inform your guests before they come onto HfH property. THIS IS A SAFETY REQUIREMENT!

2. SIGN IN – Volunteers must sign in with the date and time of arrival on the sign-in sheet and sign out when leaving. This includes Visitors, Boarders, and Volunteer participants. There are several people who use this facility. We are open to the road so if anything seems amiss, make a note of it so that we can take appropriate steps to prevent theft or damage to the property.

3. NO “BORROWING” – Do not use any tack items that are not yours personally. Those participating in the HfH Program may use the HfH items designated for the particular horse you are working with.

4. NO BURNING – No burning or open flame within 150 feet of the barns and surrounding structures and trees.

5. NO SMOKING or ‘VAPING’ ON HfH PREMISES – This is AN INSURANCE REQUIREMENT. Smoking is not allowed on any part of HfH property. Please be sure you inform any guests you may bring/invite to watch or observe HfH activities.

6. DO NOT HANDLE ANY HORSE AT ANY TIME UNTIL YOU HAVE BEEN CERTIFIED BY HfH – You may obtain a ground certification after being trained and passing an HfH “Ground Work” test administered by HfH Staff.

7. ONLY HANDLE HORSES USING THE “BUDDY SYSTEM” – Always handle horses in groups of 2 to 3 people. ALL members of the group must be ground certified or an approved student in a HfH lesson program.

8. DO NOT FEED ANY HORSE – Only HfH approved feeders are to feed horses at their scheduled time. Due to the number of folks that are present at our facility each week and for the health and well-being of our horses, we do not allow feeding of treats directly to the horses. If you would like your horse to have a treat, a staff member can assist you with putting the treat in your horse’s nightly feed bag.

9. DO NOT RIDE UNLESS YOU ARE UNDER THE SUPERVISION OF AN INSTRUCTOR – You must be enrolled in a HfH lesson program to be able to ride and must ONLY ride while under an instructors supervision.

10. PHONE READY and SILENT – While HfH staff members have cell phones ready in case of an emergency, if possible, have your own cell phone ready too in case of an emergency. Ringtones may spook the horses and distract the riders, please keep your phone on silent. Cell phone usage or videoing is NOT allowed during lessons, while working with horses, or handling horses.

11. NO WEAPONS ALLOWED – No displayed or concealed weapons (guns, knives, etc.) are permitted on the premises!

12. FAMILY ENVIRONMENT – We are a family-friendly organization that has a few do’s and don’ts:

a. DO HELP each other out.
b. DO PUT THINGS BACK where you found them.
c. DO ACT KINDLY to one another (horse or human).
d. DON’T USE PROFANITY (especially around young children).
e. DON’T SET FOOT ON ANY HfH PROPERTY WHILE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS nor bring any alcohol or drugs onto the premises.

I have read and do understand the Horses for Hope (HfH) rules stated above. I will obey these rules and any other rules posted at HfH facilities whenever I attend, participate, volunteer, and/or work at HfH. My signature indicates that I will abide by these rules throughout my time with Horses for Hope. Failure to do so, can result in the termination of my privilege of volunteering, participating, boarding, and/or visiting this equestrian center as deemed necessary by the Board and President of HfH.
Signature Parent/Legal Guardian 1*

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Name Parent/Legal Guardian 1

First NameLast Name
Signature Parent/Legal Guardian 2

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Name Parent/Legal Guardian 2

First NameLast Name
Signature Child 1

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Signature Child 2

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Signature Child 3

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Signature Child 4

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Family Volunteer Form

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