M aryl and T he rap e ut ic R iding, I nc .
Vol u nt e e r A p p l ic at ion
Please Print Clearly and Complete Fully
Name: ___________________________________________________________________________________
(Last Name)
(Full First Name)
(Nickname)
(Full Middle Name)
Mailing Address: __________________________________________________________________________
City: _______________________________________
State: ________ Zip Code: ___________________
Home Phone: ________________________________ Work Phone: _________________________________
Cell Phone:__________________________________ E-mail: _____________________________________
Text Messages:  No  Yes Encouraged for last minute cancellations!
Preferred Method of Contact:  Home Phone  Cell Phone  Work Phone  Email  Text Message
Date of Birth:____________________
Age:  14-17  18-21  22-29  30-39  40-49  50-59  60+
Height:__________________________
Needed for sidewalker assignments
(Complete this section if the volunteer is under 18 years old.)
Parent/Guardian Name: ____________________________________________________________________
Employer/Occupation: _____________________________________________________________________
Home Address: ___________________________________________________________________________
City: ________________________________________
State: _________ Zip Code: _________________
Home Phone:_____________________________ Alternate Phone: _________________________________
Employer/School:____________________________________Occupation:____________________________
□My employer gives time off for volunteering
□ My employer matches cash donations
How did you hear about MTR? ______________________________________________________________
Reason for Volunteering: ___________________________________________________________________
Horse Experience? No Yes If yes, please describe:____________________________________________
__________________________________________________________________________________________
Experience with individuals with disabilities?  No  Yes If yes, please describe: ____________________
__________________________________________________________________________________________
Can you walk for 45 minutes and jog short distances?  No  Yes
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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M aryl and T he rap e ut ic R iding, I nc .
Vol u nt e e r A p p l ic at ion
Background Information: Have you ever been charged with or convicted a crime?  No  Yes
Please explain:_____________________________________________________________________________
I, ___________________________(volunteer), 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 low, 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.
Signature:_______________________________________________________ Date:___________________
(Volunteer or Parent/Guardian if volunteer is 17 years old or younger)
Photo Release: ___ I hereby consent to and authorize the following; ___ 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.
Signature: ___________________________________________ Date: ________________________
(Volunteer or Parent/Guardian if the volunteer is 17 years old or younger.)
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.
Signature:____________________________________________ Date: _______________________________
(Volunteer or Parent/Guardian if the volunteer is 17 years old or younger.)
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.
Signature:_____________________________________________
Date:_______________________
(Volunteer or Parent/Guardian if the volunteer is 17 years old or younger.)
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M aryl and T he rap e ut ic R iding, I nc .
Vol u nt e e r A p p l ic at ion
Authorization for Emergency Medical Treatment for Volunteers
Name: ___________________________________DOB: _________________Phone:____________________
Address: _________________________________________________________________________________
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: __________________________________________________________________
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.
Signature: ____________________________________________________ Date: ______________________
(Volunteer or Parent/Guardian if the volunteer is 17 years old or younger)
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:
__________________________________________________________________
__________________________________________________________________
____________________________________
Signature: _______________________________Date: ___________
(Parent/Guardian if the volunteer is 17 years old or younger)
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M aryl and T he rap e ut ic R iding, I nc .
Vol u nt e e r A p p l ic at ion
Volunteer Opportunities
Your Volunteer Interests: please place a check in 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 Riders
□Horse Leading (horse experience preferred; additional training required for all interested)
● Equine Program Volunteer
□Horse Care, Feeding, Cleaning Paddocks, etc.
● Facility/Farm Volunteer
□General Maintenance and Repairs
● Office Volunteer
□Data Entry □ Reception
□Carpentry
□Equipment Repair □ Gardening
□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.
7-9AM
9AM-11AM
11AM-2PM
2PM-4PM
4-6PM or 7PM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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: _____
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.
Return completed forms to: Volunteer Manager, Maryland Therapeutic Riding, 1141 Sunrise Beach Rd, Crownsville, MD 21032
Email: volunteer@mtrinc.org Phone: 410-923-6800 Fax: 410-923-1432
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