First, let's get your basic info. We use Wranglr for helping to schedule our volunteers. Please enter your name, email and mobile number. This info will be used to communicate openings, your schedule and important info from Healing Strides. Make sure you have access to both the email account and the mobile for texts.
Why do we need this info? Some volunteering roles and duties might require you to work with larger horses, carry heavier things, etc. We also work with Participants that have many different needs and the below information helps us make more informed decisions for our Participants and Volunteers. Please fill out whatever info you are comfortable sharing with us.
Experience and Health Info
In the event emergency medical aid/treatment is required due to illness or injury during the process of reciving/giving services, or wile being on the property of HSVA or activity site, I authorize Healing Strides of VA to:
1) Secure an dretain medical treatment and transportation if needed.
2)Release client records upon request to the suthorized individual or agency involved in teh medical emergency treatment.
This authorization includes X-Ray, hospitalization, medication an dany treatment procedure deemed "life-saving" by the physician. This provision will only be invoked if the person consenting below is non-responsive in a medical emergency.
Volunteering is a powerful force that not only transforms the lives of those we serve but also enriches our own. It is through the selfless act of giving that we discover the true essence of community and compassion. By contributing our time and skills, we become instrumental in creating positive change and fostering a sense of unity.
Important Information and Acceptances
General Liability Release
As a participant with Healing Strides of VA, I acknowledge and understand the risks and potential risks of a horseback riding program including but not limited to, (i) the propensity of an equine to behave in dangerous ways, which may result in injury or death to the participant or damage to property; (ii) the inability to predict an equine's reaction to sound, movements, objects, persons or animals; (iii) hazards of surface or subsurface conditions whether known or unknown; (iv) the condition and age of the equipment or tack, however, I feel that the possible benefits to myself and the participant I work with are greater than the risk I assume. I hereby, intent to be legally bound, for myself, my heirs and assigns, executors or administrators, and waive and release forever all claims for damages against-Healing Strides of VA, their board of directors, instructors, therapists, aides, volunteers, employees and their respective families, for any and all injuries and/or losses I may sustain while participating in Healing Strides of VA. I further certify that the foregoing statements and representations are being made by me knowingly, freely and voluntarily, and I understand that Healing Strides of VA is expressly relying upon the foregoing statements and representations in permitting me to participate in programs at Healing Strides of VA.
ACHKNOWLEDGEMENT OF HSVA CONFIDENTIALITY POLICY
* Due to the nature HSVA's programs, we are entrusted with sensitive personal information. Our clients are entitled to assurance of protection from
unwarranted invasion of personal privacy. The Privacy Act, State and Federal Laws, regulations from licensing agencies and our basic constitutional
rights are designed to protect us all from unwarranted invasion of privacy.
* No information about a client, including enrollment or residence, in written or any other form, may be disclosed to any person or organization
without proper authorization. (The only exception is in a life-threatening emergency, in which necessary medical information may be disclosed to
emergency personnel to expedite treatment). HSVA staff is responsible for reviewing all requests for information to ensure that the proper
authorization has been obtained.
* Again, our records contain sensitive client information, which is protected by law from unauthorized disclosure. HSVA holds the moral and legal
obligation to protect the interests of both our clients and employees. By signing the confidentiality agreement, I commit to protect the privacy of
HSVA clients, both past and present.
* I have read the above and agree to maintain this policy during and after my tenure with HSVA. I realize that this document will become a permanent
record at HSVA. I further realize that failure to comply with the policies on confidentiality could impact my involvement at HSVA.
Consent to Electronic Signature
By checking this box you consent to an electronic signature.