Simple Job Application Form

Miles Ranch Volunteer Application

Please complete the form below to apply for a position with us.
Full Name *

First Name Middle Name Last Name
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email Address
Phone Number

Area Code Phone Number
Upload Resume
Demographics
Are 18 years of age or older?
Ethnicity (for grant purposes) *
Emergency Authorization Form

In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on the property of the agency, I authorize Miles of Smiles Foundation's Equine Therapy Program to:

1. Secure and retain medical treatment and transportation if needed.
2. Release client records upon request to the authorized individual 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(s) below is/are unable to be reached.
Physicians Name
Preferred Medical Facility
Health Insurance Company
Policy #
Allergies
Current Medications
In the event of an emergency, contact:
Phone Number

Area Code Phone Number
I consent to and authorize the use and reproduction by Miles of Smiles Foundation's Equine Therapy Program 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.
*

Yes I consent I DO NOT consent
Confidentiality Agreement

By clicking on the box below, I understand that all information (written and verbal) about participants at the Miles of Smiles Foundation's Equine Therapy Program is confidential and will not be shared with anyone without the express written consent of the participant and their parent/guardian in the case of a minor.
Skills & Experience

In which of these areas do you feel you have moderate to excellent skill? Check all that apply.
Please check which skills you have and what areas you are interested in helping out. Also, please answer the questions below regarding your experience with horses.
AED Certified CPR Certified Grant Writing Social Media Marketing Experience Fundraising
Interests

Barn / Horse Support Events Support Landscaping Facility Cleaning Event Committees Fundraising
Have you ever owned or leased a horse?
How confident are you grooming?
How confident are you tacking a horse?
How confident are you leading horses?
Should be Empty:

Miles Ranch Volunteer Application

Demographics