Volunteer Application
01
Core Information
02
Consent Forms
03
Emergency Contact Information
04
Volunteer Opportunities
Volunteer Application
Name
Mailing Address
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua & Deps
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherland
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St Kitts & Nevis
St Lucia
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Other
Home Phone
Work Phone
Cell Phone
Email
Preferred Method of Contact
Home Phone
Work Phone
Cell Phone
Email
Text Message
1
Text Messages (Encouraged for last minute cancellations)
Yes
No
Date of Birth
Age
14-17
18-21
22-29
30-39
40-49
50-59
60+
Height
Needed for sidewalker assignments
Parent/Guaridian Name
Complete this if volunteer is under 18 years old
Parent/Guardian Employer or Occupation
Complete this if volunteer is under 18 years old
Parent/Guardain Address
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua & Deps
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherland
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St Kitts & Nevis
St Lucia
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Other
Complete this if volunteer is under 18 years old
Employer/School:
Occupation
My employer gives time off for volunteering
My employer matches cash donations
How did you hear about MTR
Reason for volunteering
1
Horse Experience?
No
Yes
If yes, please describe
1
Experience with individuals with disabilities?
No
Yes
If yes, please describe
1
Can you walk for 45 minutes and jog short distances?
No
Yes
1
Can you hold your arm above shoulder height and support a modest amount of weight?
No
Yes
Please describe any disorders, medical conditions or injuries that may impact your ability to manage the physical and/or emotional demands of working in equine assisted activities. Volunteer responsibilities may include communicating with others, following directions, working independently, walking for extended periods of time, jogging short distances, working in hot/humid/cold conditions, working with clients who may have mild to severe mental and/or physical challenges, and working with large animals.
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Background information
1
Have you ever been charged or convicted of a crime?
No
Yes
If yes, please explain
I authorize Maryland Therapeutic Riding 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 that I expressly DO NOT authorize the PATH Intl. center, it’s directors, officers, employees, or other volunteers to disseminate this information in any way to any other individual, group, agency, organization, or corporation. Please print your name below.
Electronic Signature
Clear
Volunteer signature or parent/Guardian signature if the volunteer is 17 years old or youndger
Date
Photo Release
I hereby consent to and authorize Maryland Therapeutic Riding, Inc.’s use and reproduction of any and all photographs and other audiovisual material taken of me for promotional printed materials, social media, educational activities, exhibitions, or for any other use for the benefit of the program.
I do not consent to, nor do I authorize Maryland Therapeutic Riding, Inc.’s use and reproduction of any and all photographs and other audiovisual material taken of me for promotional printed materials, social media, educational activities, exhibitions, or for any other use for the benefit of the program.
Clear
Volunteer signature or Parent/Guardian signature if the volunteer is 17 years old or younger
Date
Affirmation
I understand that: 1) In the course of volunteering for MTR, I may be dealing with confidential information about MTR rider’s medical information and I agree to keep said information in the strictest confidence. 2) I need to ask staff permission prior to taking any pictures or videos. 3) The relationship between MTR and volunteers is an “at will” arrangement and it may be terminated at any time without cause by either the volunteer or MTR. 4) I am responsible for informing MTR of ALL changes regarding information contained in this application and for updating all paperwork annually. I affirm that I have read and understand this application and that the information given is true and complete. I also understand that in the event false information is provided, I may be terminated from my volunteer position.
Clear
Volunteer signature or Parent/Guardian signature if the volunteer is 17 years old or younger
Date
Release of Liability
I recognize that horseback riding, assisting in riding lessons, caring for, and being in the near vicinity of, horses are high risk activities. I hereby agree that my involvement in such activities and/or my presence on MTR premises is at my own risk. I hereby release MTR, its officers, employees, volunteers and agents from any and all liability arising out of my participation in such activities and/or my presence on MTR premises (including costs and attorney’s fees) regardless of whether or not liability is premised on negligent actions or omissions of such released parties or otherwise. I hereby agree to indemnify and hold harmless MTR, its officers, employees, volunteers and agents from any and all suits, actions, claims of any type arising out of my involvement in such activities and/or my presence on MTR premises whether or not such suits, etc. are premised on negligent actions or omissions of such indemnified parties or otherwise. I have read this agreement and fully understand its contents.
Clear
Volunteer signature or Parent/Guardian signature if the volunteer is 17 years old or younger
Date
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Authorization for Emergency Medical Treatment for Volunteers
Name
Date of Birth
Phone
Address
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua & Deps
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherland
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St Kitts & Nevis
St Lucia
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Other
In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize the staff of Maryland Therapeutic Riding, Inc. to: 1. Secure and retain medical treatment and transportation if needed. 2. Release records upon request to the authorized individual or agency involved in the medical emergency treatment.
In the event of an emergency, contact:
Name
Relation
Phone
Name
Relation
Phone
Name
Relation
Phone
Physician's Name
Preferred Medical Facility
Health Insurance Company
Policy #
Please indicate any allergies you may have:
I am taking the current Medications:
I have the following ongoing medical condition(s):
CONSENT PLAN
This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed “lifesaving” by the physician. This provision will only be invoked if the person(s) above is unable to be reached.
Clear
Volunteer signature or Parent/Guardian signature if the volunteer is 17 years old or younger
Date
OR Non-Consent Plan
I do not give my consent for emergency medical treatment/aid in the case of illness or injury while being on the property of the agency.
Parent or legal guardian will remain on site at all times while volunteering
In the event emergency treatment/aid is required, I wish the following procedure to take place:
Electronic signature
Clear
Volunteer signature or Parent/Guardian signature if the volunteer is 17 years old or younger
Date
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Volunteer Opportunities
Your Volunteer Interests:please check the box next to your interest(s)
Lesson Program Volunteer: I am interested in volunteering for the riding program in the following way(s):
Sidewalking with Riders
Horse Leading (horse experience preferred; addtional training required for all interested)
Equine Program Volunteer
Horse Care,Feeding, Cleaning Paddocks, etc.
Facility/Farm Volunteer
General Maintenance and repairs
Carpentry
Equipment Repair
Gardening
Office Volunteer
Data Entry
Reception
General Office Support
Special Events Volunteer
Serve on Special Event Planning Committees
Provide Assistance Day of an Event
House Keeper
Assist with keeping office buildings clean and tidy
Special Skills Volunteer: If you have skills, technical or professional experience that may be beneficial to MTR we encourage you to share them with us.
Photography
Construction
Grant Writing
Computers
Website/Graphic Design
Other
Please Indicate your Volunteer Availability.
Your volunteer schedule will be arranged with the Volunteer Manager after Volunteer Orientation. Volunteers are encouraged to serve a minimum of 2 hours per week.
Monday
7am-9am
9am-11am
11am-2pm
2pm-4pm
4pm-6pm or 7pm
Tuesday
7am-9am
9am-11am
11am-2pm
2pm-4pm
4pm-6pm or 7pm
Wednesday
7am-9am
9am-11am
11am-2pm
2pm-4pm
4pm-6pm or 7pm
Thursday
7am-9am
9am-11am
11am-2pm
2pm-4pm
4pm-6pm or 7pm
Friday
7am-9am
9am-11am
11am-2pm
2pm-4pm
4pm-6pm or 7pm
Saturday
7am-9am
9am-11am
11am-2pm
2pm-4pm
4pm-6pm or 7pm
Sun
7am-9am
9am-11am
11am-2pm
2pm-4pm
4pm-6pm or 7pm
How many days per week would you like to volunteer?
How many hours per day would you like to volunteer?
In addition to your scheduled day and time, would you like to be on the Volunteer Substitute list?
Yes
No
What is the best way to contact you for filling a substitute spot?
Home Phone
Cell Phone
Work Phone
Email
Text Message
MTR's program runs in 10 week sessions. Volunteers are asked to commit to the same day and same time for the duration of the session to develop a “team” for each rider. If you have a work or family situation that prohibits this commitment, please suggest an alternative schedule:
Please do not solicit me for funds on behalf of MTR.
Please do not include me on the MTR mail list for general information.
Verification
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SUBMIT FORM
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