SOUTHERN STARRS,
Dear Volunteer Applicant:
Thank you for your interest in becoming a volunteer for Southern STARRS. Please find enclosed a
volunteer job description and the form to fill out to become one of our volunteers. Please read the job
descriptions, complete forms, and return by mail to Southern STARRS, Inc., 4050 Cairo Bend Rd.
Lebanon, TN 37087 or scan and email to volunteer@southernstarrs.org.
Please be sure to fill in the times you are available, and write in how many hours per week you are
interested in volunteering (this is up to you, we appreciate any time that you are willing to give!) Volunteer
training sessions are scheduled periodically as new volunteers apply.
Classes are held on Saturday mornings, and Monday, Tuesday and Thursday evenings. Volunteers are
needed to work Saturdays from 8:30 a.m. to 12:30p.m., or weekday evenings 4:30 p.m. to 7:00 p.m. We
especially need Tuesday evening volunteers. We will not ask you to work more than one day a week unless
you request to do so.
After a training session, at which time you will be given a volunteer handbook, you will be assigned to a
regular schedule. Please return your completed forms to the above address or email
volunteer@southernstarrs.org. You will be contacted to confirm your schedule.
Class sessions run for 8-10 weeks at a time. You are invited to participate as a volunteer for as long as your
schedule allows, but we do ask that you commit to at least 1 session.
If you have questions, call our office: 453-2592, or email: twinfield@southernstarrs.org.
Southern STARRS is a non-profit agency that relies on volunteer and community support. Your
willingness to give of your time so that a child may ride is very much appreciated.
Sincerely,
Terry Winfield, Executive Director
Lauran Douglass, Program Manager
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SOUTHERN STARRS, INC.
Volunteer Job Descriptions
NOTE: Although some positions are noted to have preferable experience, training is provided and lack
of experience with either horses or individuals with disabilities does not prevent you from being a
volunteer. Volunteers must be able to walk up to 45 minutes, and jog for short intervals. Volunteers
should have the strength to help a rider balance during classes (be able to lift 30 lbs.) Volunteers who
have served 6 months or more are occasionally invited to help exercise horses at the Executive
Director’s discretion. Before a volunteer is allowed to ride, however, they must pass a written test to
determine their level of horse experience.
Working during sessions:
1. Leader - Responsible for helping students mount and dismount before and after class, maintaining
control of horse during riding sessions and following directions of riding instructor, and encouraging
student to participate in guiding the horse as much as possible. Also assists in saddling and
unsaddling assigned horses, and grooming. (Experience with horses preferred.)
2. Side Walker - Assists assigned student to mount and dismount for riding session. Walks beside
horse during sessions to monitor or help support student while he/she is mounted. Helps rider
maintain balance. Helps rider participate in class activities. Instrumental in student's safe removal
from horse if an emergency dismount is necessary. (Extremely responsible position - volunteer must
be in reasonably good physical condition.)
3. Ring Assistant - Helps set up games and equipment before or during riding session. Assists
Riding Instructor in conducting exercises or games for students during sessions. Helps to dismantle
and put up equipment after session.
Working off session:
1. Facility Maintenance Team – Routinely, STARRS will need help with stable chores such as
trimming weeds, helping to pick up trash on facility grounds, periodic stacking of hay bales,
cleaning tack, etc.
2. Special Events - The facility participates in special events either on-site or at the site of another
organization. These events include off-site therapeutic horseback riding, fundraising, and
community education. There is always a need for extra volunteers to help with these events.
We occasionally trailer horses to another site to allow groups to participate in short Therapeutic
Riding sessions and these events require extra volunteers. If volunteers have friends or family
members that would like to participate in a fundraising event, they do not have to be regular
program volunteers and are welcome.
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SOUTHERN STARRS, INC.
Special Therapeutic And Recreational Riding Students
4050 Cairo Bend Rd * Lebanon, TN 37087 * Phone (615) 453-2592
VOLUNTEER INFORMATION FORM
Name: _____________________________________ Date of Birth (if under18)/ Day & Month if over 18: ________
Home Phone: _________________ Email: (preferred contact) ________________________________________
Address: _______________________________________ City _________________ State ______ Zip _______
Work Address: __________________________________ City: _________________ State ______ Zip _______
Work Phone: ________________________ Cell: _____________________ Fax: ______________________
Parent/Guardian Name and Address (if under 18) ________________________________________________
_________________________________________________________________________________________
If student, name of school: _________________________________ How did you learn about Southern
STARRS: _______________________________________________________________________________
Experience: (please give a brief summary of any experience you have had with children who have a disability,
or experience with horses)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
I am available for the following jobs (check all that apply):  Sidewalking  Leading Horse  Grooming horse
 Feeding horses,  Cleaning Tack  Ring Assistant  Facility maintenance  Working special events
Times Available:
Monday:________ Tues: ________Thursday:________ Saturday: _________
Frequency Available: Weekly______ Bi-Weekly______Monthly______ Available for Special Events: ______
PHOTO RELEASE: (optional)
I consent to and authorize the use and reproduction by Southern STARRS of any and all photographs and audiovisual materials in which I may appear, for promotional material, educational activities, exhibitions or for any
other use for the benefit of the program.
Date: _________________ Signature: _____________________________________________________
VOLUNTEER LIABILITY RELEASE: (mandatory - if under 18, must be signed by parent)
As a volunteer at Southern STARRS, I acknowledge the risks and potential for risks of a horseback riding
program. However, I feel that the possible benefits to myself and the clients with whom I work are greater than
the risk 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 Southern STARRS, its board of
directors, instructors, therapists, volunteers, contributors and /or employees for any and all injuries and/or losses
I may sustain while participating with Southern STARRS.
DATE: _______________ Signature: ____________________________________________________
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SOUTHERN STARRS, INC.
Special Therapeutic And Recreational Riding Students
4050 Cairo Bend Rd * Lebanon, TN 37087 * Phone (615) 453-2592
VOLUNTEER'S AUTHORIZATION FOR EMERGENCY
MEDICAL TREATMENT FORM
(Information remains confidential for supervisor reference in case of emergency)
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 Southern STARRS to secure and retain
medical treatment and transportation if needed.
Volunteer's Name: ________________________________________________ Phone: _____________
Address: ____________________________________________________________________________
Contact in an Emergency: Name: ____________________________________ Phone: _____________
Name: ___________________________________ Phone: ______________
Physician's Name: ________________________________________________ Phone: ______________
Preferred Medical Facility: ______________________________________________________________
Health Insurance Company: _____________________________________________________________
Policy #: (Write in or attach copy of card): __________________________________________________
Allergies: ____________________________________________________________________________
Current Medications: ___________________________________________________________________
(Above information is for medical facility use only)
Choose one of the following:
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 below is unable to make their own
determination or is a minor.
Date: ____________ Consent Signature: __________________________________________________
(Parent or Guardian if under 18)
Print Name: __________________________________________________ Phone: _________________
Address: ____________________________________________________ Other Phone: ____________
NON-CONSENT PLAN
I do no give my consent for emergency medical treatment/aid in the case of illness or injury during the process of
receiving services or while being on the property of the agency. In the event emergency treatment/aid is
required, I wish the following procedures to take place:
_________________________________________________________________________________________
_________________________________________________________________________________________
__________________________________________________________________________Date:___________
Non-Consent Signature: ______________________________________________ (parent or guardian if under 18)
Print Name: _____________________________________________________ Phone: ______________
Address: ____________________________________________________________________________
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PLEASE LIST THREE PERSONAL REFERENCES WHO ARE WILLING TO PROVIDE A
WRITTEN RECOMMENDATION. (At least one must be someone other than a friend or coworker. For example: employer, clergy, teacher, counselor, professional colleague.)
Reference forms will be sent to the individuals listed.
1. NAME____________________________________RELATIONSHIP________________
Email Address (preferred) __________________________________________________
STREET ADDRESS_______________________________________________________
CITY__________________________________STATE________________ZIP_________
PHONE__________________________
2. NAME____________________________________RELATIONSHIP________________
Email Address (preferred) __________________________________________________
STREET ADDRESS_______________________________________________________
CITY__________________________________STATE________________ZIP_________
PHONE__________________________
3. NAME____________________________________RELATIONSHIP________________
Email Address (preferred) __________________________________________________
STREET ADDRESS_______________________________________________________
CITY__________________________________STATE________________ZIP_________
PHONE__________________________
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CRIMINAL BACKGROUND CHECK (age 18 or older)
AUTHORIZATION AND REQUEST
The following individual has made application to Southern STARRS, Inc. seeking training and service
as a Therapeutic Riding Team Volunteer. In compliance with Standards and Practices of the North
American Riding for the Handicapped Association, a criminal background check must be obtained and
kept on file.
Name: _________________________________________ DOB: ________________________
Maiden Name if Applicable: _____________________________________________________
Address:_____________________________________________________________________
Social Security #: __________________________ TN Driver's License: __________________
Phone: _____________________________ Other Driver's License #: ____________________
Sex: _______________________
Race: ____________________
If current residency is less than 5 years, former address:
Results: _____________________________________________________________________
____________________________________________________________________________
Information Recorded By: ___________________________________ Date: ______________
Authorization for Release of Information:
I authorize the Southern STARRS program to obtain information concerning my suitability to become a
volunteer for this agency from the Department of Human Services; the Child Abuse Register; the
Department of Corrections; the District Attorney's Office; juvenile, civil and criminal court records; the
Department of Motor Vehicles; and/or law enforcement records.
____________________________________________
Signature
________________________
Date
Information obtained under the above release shall be held in confidence and shall be used
exclusively to determine suitability to serve as a volunteer.