Minor Volunteer
Application
Name
Birth Date
Address
City, State, Zip Code
Cell Phone
Email
Employer/School
Medical:
Date of Last Tetanus Shot:
Please fill in the blanks under the days you are available, with the times you will be available.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AM
PM
Other:_____________________________________________________________________
__________________________________________________________________________
Please provide the following emergency information:
Emergency Contact Name / Relation
Home Phone
Mobile Phone
Work Phone
Please complete the following questions about yourself and your experience with horses:
How many years of experience do you have…
Leading horses _______
Grooming horses _______
Providing basic hoof care/cleaning _______
Feeding horses _______
Lunging horses ________
Working with mini horses/ponies _______
Training horses with ground work _______
Riding well trained horses _______
Starting a horse under saddle _______
Riding “green” broke horses ______
Providing medical assistance to horses _______
Working with an average size horse _______
Working with a draft type horses _______
Stall mucking _______
Full care and/or maintenance of a horse _______
Working with a young horse (less than 1 yr.) _______
Working with a wild mustang _______
Please describe your horse experience, based on the year of experience that you have marked above:
Please describe any other experiences or talents that you would like to let us know about:
*Don’t worry if you have little or no experience with horses, we have training available for our volunteers!*
Other areas of volunteering that you are interested in:
_____Participating at Events
_____Newsletter
____ Marketing & Promotion
______Grant Writing
_____Coordinating Events & Fundraisers
Other skills or training that would be helpful to our organization:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Do you have any medical limitations or are you on any prescription medications?
Yes _____ No_____
If Yes, please describe your conditions and alert us to how to help you in an emergency
situations:
The following questions are for the safety of our staff and other volunteers, this
information will remain confidential:
(1) Have you ever been convicted of a felony?
If you selected Yes, please explain.
Yes ______
(2) Have you ever been convicted of a sexual offense?
If you selected Yes, please explain.
No______
Yes ______
(3) Have you ever been convicted of animal cruelty or neglect?
If you have selected Yes, please explain.
No ______
Yes ______
No ______
I understand that by signing this application, I am applying to volunteer at SHERR/Safe Haven Equine Rescue
and Retirement and understand that for any reason my application may be denied. I also understand that the
information I’ve provided may be used to request a background check, including criminal records to verify
personal information. By signing this application I am verifying that all information I’ve provided is accurate.
Print Name
Signature
Date
Print Name of Parent / Guardian
Signature (If Under 18 yrs.) Leave
blank upon arrival if you are
under the age of 18 years
Signature
Date
Safe Haven Equine Rescue & Retirement
MONOR VOLUNTEER LIABILITY WAIVER & RELEASE
By this agreement, made and entered this ____ day of _____, 20___, by and
between______________________________________, who resides at
_________________________________________________________, and Safe
Haven Equine Rescue & Retirement, Anne Crowder Land/Property Owner and the facility located
at 245 Cedar Ridge Lane, High Point, NC herein referred to as “The Stable”.
It is hereby agreed to as follows:
1.
That I, the undersigned, do for myself or on behalf of my child or legal ward, hereby
request to participate in activities as a volunteer.
2.
That the parent/guardian and volunteer understands that horses are unpredictable by
nature: that when frightened or angry or under stress, a horses natural instincts are to
jump forward or sideways, to run away from danger at high speeds, to kick, to jump, to
back up, to rear up on their hind legs, to bite, that horses are extremely powerful; and
that if a rider falls from a horses back to the ground, the fall distance will generally be
between 3 ½ - 5 ½ feet. I can get stepped on or knocked down. I understand these
risks and, voluntarily assume these risks and dangers.
3.
That the parent/guardian and volunteer understands that hereafter upon mounting a
horse or solely handling a horse from the ground, that the volunteer is in primary
control of the horse and that neither Safe Haven Equine Rescue & Retirement, Anne
Crowder Property/Land owner nor the other volunteers, employees, boarders, visitors
or patrons are responsible for the volunteers actions or inactions. The volunteer further
agrees not to abuse or misuse, or deliberately agitate the horse as these actions may
result in an increased risk to himself/herself and others.
4.
That I have been told that all volunteers under the age of 18 doing any riding must wear
an approved safety helmet. I have been advised that it is recommended that ALL riders
wear helmets.
5.
Liability Release: That I understand that I am responsible for bodily injury or property
damage which I or my child/legal ward should sustain on Safe Haven Equine Rescue &
Retirement premises, Anne Crowder Property/Land owner and/or neighboring
properties and/or trails and/or while riding or handling a horse, and/or while in transit
to horse shows, trail rides, fundraising events or other similar expeditions, and for any
time I or my legal ward/child shall lose from employment or school or any other
activity, and for medical expenses or any other expenses incurred because of such
bodily injury or property damage. I am aware that I should have my own health and/or
accident insurance.
That I hereby, for myself, my heirs, administrators, and assigns release and discharge
the owners Anne Crowder Property/Land Owner, operators, managers, instructors,
boarders, staff, sponsors, insurance companies, volunteers, guests, patrons, and all
other participants of Safe Haven Equine Rescue & Retirement from all claims,
demands, actions, and causes of action for such injuries sustained to my person, or that
of my child or legal charge and/or property.
I understand that while I/my child is volunteering on the property – due to the nature
of a barn and the surrounding environment – that there is the possibility of coming in
contact with poisonous snakes and/or spiders, or being around rusty fencing, nails,
wood splinters, etc. and that I am releasing Safe Haven Equine Rescue & Retirement,
Anne Crowder Property/Land owner and the facility located at 245 Cedar Ridge Lane,
High Point, NC, the owners, their insurance carriers, volunteers, and organizers should
I become injured in any way due to such circumstances.
Under North Carolina Law, an equine activity sponsor or equine is not liable for 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
Please print all information except for signature
Name of Volunteer______________________________________________________
Name of Parent/Legal Guardian_____________________________________________
__________________________________________
Signature of Volunteer or Parent/Legal Guardian
___________________________________________
Witness Signature
________________
Date
________________
Date