CHP Volunteer Form

Do you possess any special skills that would benefit CHP? *
Example: Farrier, photographer, fundraiser, computer expert, social media, languages, grant writing?
Please Tell Us About Your Experience With Horses *
Please Tell Us about Your Experience With Disabilities *

Volunteer Confidentiality Statement

Volunteers are a valuable part of Chastain Horse Park (CHP). This document confirms that I am recognized as a volunteer of CHP, which exists to provide quality recreation and therapy services, in a safe environment. This document is in compliance with the provisions of the volunteer immunity law.

As a volunteer of CHP, I have completed available and appropriate training. I understand and agree that in the performance of my duties as a volunteer, I must hold personal and medical information regarding riders/families confidential. Clients’ issues may be discussed with the CHP Volunteer Coordinator, Director, Staff, Instructors, and/or the Physical or Occupational Therapist directly associated with the CHP volunteer support meetings.

I understand that all information (written and/or verbal) about participants at this center is confidential and will not be shared with anyone outside the center. I will endeavor to keep my standards of conduct high in order to uphold the quality of the CHP program.
Signature (if under 18 a parent or guardian must sign) *

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Volunteer Liability Release

As a volunteer for CHP, I acknowledge the risks and potential for risks of at an Equine Assisted Activities & Therapies Program. However, I believe that possible benefits to the clients I work with and myself are greater than the risks 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 CHP, its Board of Directors, Executive Director, Instructors, Therapists, Volunteers and/or Employee for any and all injuries and/or losses I may sustain while participating with CHP.

WARNING: Under Georgia law, an equine activity sponsor or equine professional is not liable for an injury or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to Chapter 12 of Title 4 of the Official Code of Georgia Annotated.
Signature (if under 18 a parent or guardian must sign) *

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CHP & PATH Intl. Photograph, Film, Media, & Publicity Release

I Consent to and authorize the use and reproduction by CHP of any and all photographs and any other audio/visual materials taken of me for promotional material, Facebook, educational activities, exhibitions, or for any other use for the benefit of the program.
Signature (if under 18 a parent or guardian must sign) *

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Have you ever been convicted of a criminal offense or have a conviction pending, including any misdemeanors? (Do not include convictions that are sealed, eradicated or expunged, or convictions that resulted in referral to a diversion program).
NOTE: Convictions may not necessarily disqualify a prospective candidate. If Yes, please explain.
I authorize CHP to 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 or animals. I understand that such access is for the purpose of considering my application as a volunteer, and I expressly DO NOT authorize the PATH center, its directors, officers, employees, or other volunteers to disseminate this information in any way to any other individual, group, agency, organization, or corporation.
Signature (if under 18 a parent or guardian must sign) *

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Volunteer Code of Conduct

By signing this agreement I agree to the following:
- I understand that the goal of volunteering is to engage and educate the public, and my attitudes and actions should always further that goal.
- I agree to work my entire volunteer shift as scheduled, to conduct myself in an appropriate manner, to dress in attire that follows the volunteer dress code, to follow safety procedures, and to be prepared for my shift.
- I understand that if I cannot make a volunteer shift (or any part of a shift), it is important to notify the Volunteer Coordinator ahead of time by emailing volunteer@chastainhorsepark.org AND calling the supervising instructor of that session directly.
- During my scheduled volunteer shift, I agree to follow directions given by staff, and understand that while I am at the riding center my focus should be on the client/horse/duties assigned to me.
- I understand that I am responsible for reviewing all materials given to me at orientation and trainings.
- I know that I represent CHP, and I promise not to engage in any activity that may cause harm to the organization, others or me.
- I understand that failing to observe the above pledges will result in further action and can result in my dismissal from the volunteer program.
Signature (if under 18 a parent or guardian must sign) *

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Type a question

I DO give my consent and authorization in the event emergency medical aid/treatment (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed "life saving" by the physician) is required due to illness or injury while being on the property of the agency. In case of medical emergency or necessity, CHP is authorized to seek or provide for “Volunteer” such medical assistance as may be necessary, “Volunteer” further authorizes CHP to secure and retain medical treatment and transportation if needed, 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 “Volunteer”. The undersigned hereby agrees to pay all fees and expenses of doctors, hospitals, ambulances and other medical expenses reasonably and necessarily incurred. I DO NOT give my consent for emergency medical treatment/aid in the case of illness or injury while being on the property of CHP. In the event emergency treatment/aid is required, I wish the following procedure to take place:
Prefered Action If indicated Above

Emergency Contact 1 *

First Name Last Name
Emergency Contact 1 *

Area Code Phone Number
Emergency Contact 1 *
example@example.com
Emergency Contact 2 *

First Name Last Name
Emergency Contact 2 *

Area Code Phone Number
Emergency Contact 1 *
example@example.com
Please Indicate Any Allergies *
Current Medications *
Prefered Medical Facility *
Prefered Provider *
Health Insurance Carrier
Policy Number
Signature (if under 18 a parent or guardian must sign) *

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Should be Empty:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Chastain Horse Park Volunteer Forum