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Therapeutic Riding At Centenary Volunteer Application

Thank you for your interest in volunteering for Therapeutic Riding At Centenary (TRAC)! TRAC provides equine-assisted services (EAS) to individuals with special needs, and develops leaders for the EAS-industry. To fulfill this mission, we rely on the support of 75+ dedicated volunteers each year! We look forward to having you join us! Volunteers age 18+ should complete this application. In the case of volunteers under the age of 18, please request a paper application to allow for signatures from both you and your parent or legal guardian.

Basic Info

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 Therapeutic Riding At Centenary. Make sure you have access to both the email account and the mobile for texts.

First Name *

Last Name *

Email *

Mobile *

Photo & Publicity Release

I voluntarily agree to participate in the making of publicity material produced by Centenary University’s Office of Marketing and Public Relations. In consideration of my participation, I hereby give Centenary University permission to use my name, likeness, image, voice and appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, print production, testimonials and the like (“Promotional Media”), taken or made by or on behalf of Centenary University, its agents or assigns. I agree that Centenary University has complete ownership of the Promotional Media, including the entire copyright and may use and edit such media in its entirety, or any portion thereof, for any purpose consistent with its mission. These uses include, but are not limited to illustrations, bulletins, exhibitions, websites, videotapes, reprints, reproductions, publications, advertisements, classroom exercises, coursework, course guides, catalogues, handbooks, Viewbooks and any other promotional, marketing and educational materials in any medium now known or later developed, including the Internet. I further agree that Centenary University staff photographers shall retain the rights to all “outtakes” and can make duplicates of original images for his or her individual self-promotion and staff portfolios. I acknowledge that I will not receive any compensation for Centenary University’s use of the Promotional Media and I hereby waive any and all claims for remuneration in any form for my performance or service in connection with the making of the Promotional Media. I understand that upon request, I shall receive screen credit for my participation. I hereby release Centenary University and its directors, officers, agents, employees and assigns from all claims which arise out of or are in any way connected with the use of the Promotional Media described herein. I further acknowledge that this consent and release is of perpetual duration. I certify that I am 18 years of age or older. I have read and understood this consent and release.

YES - I CONSENT to photos/publicity release

NO - I DO NOT CONSENT to photos/publicity release

Additional Info

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.

Height

Weight

Gender Identity

Please Share Your Pronouns (optional)

T-Shirt Size

Driver's License (State and # please)

Birth Date*

Parent/Guardian/Caregiver Info

If you are a minor or an adult with legal guardians/caregivers, or are filling out this application on behalf of someone else, please include Parent or Guardian/Caregiver info below.

Parent or Guardian/Caregiver Name

Parent or Guardian/Caregiver Phone

Parent or Guardian/Caregiver Email

Contact Info

Street Address *

Additional Address Info

City *

State *

Postal code *

Country *

Emergency Contact

Emergency Contact Name *

Emergency Contact Relation *

Emergency Contact Phone *

Experience and Health Info

Do you have any previous horse experience? *

Have you had any previous experience working with people with special needs? *

Have you ever been convicted of a crime?

If so, please explain below

Enter your School or Employer name *

Pre-existing Health Conditions (put n/a if none) *

Please list all medication you are taking (including medical marijuana) (put n/a if none) *

Please note any allergies and if EpiPen or inhaler is used (put n/a if none) *

What is your general health status? Tell us about any special needs or health concerns *

Do you have Health Insurance?

Insurance Details - please put company and coverage dates

Medical Waiver

I understand and agree that TRAC/Centenary University will not have medical personnel available at the location of the Program/Activity. 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 TRAC and/or Centenary University to secure and retain medical treatment and transportation if needed. I further authorize and consent to the University contacting emergency and/or medical personnel and to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care that may be deemed necessary for my safety and protection. I further authorize TRAC/Centenary University to release client records upon request to the authorized individual or agency involved in the medical emergency treatment. In the event of any medical emergency, I understand and agree that TRAC/Centenary University assumes no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.

I accept the medical waiver *

Important Information and Acceptances

General Liability Release

ELECTIVE PARTICIPATION: I acknowledge that my participation is elective and voluntary and that my participation is not required by the University. RULES AND REQUIREMENTS: I agree to conduct myself in accordance with Centenary University’s policies and procedures. I further agree to abide by all the rules and requirements of the Program/Activity. I acknowledge that the University has the right to terminate my participation in the Program/Activity if it is determined that my conduct is detrimental to the best interests of the group, my conduct violates any rule of the Program/Activity, or for any other reason in the University’s discretion. INFORMED CONSENT: I have been informed of and I understand the various aspects of the Program/Activity, including but not limited to traveling to and from Program/Activity site via private vehicle, common carrier, and/or University owned vehicle, behavior of the equine animals, conditions of facilities, injuries due to conditions of equipment, weather conditions, wildlife, negligent first aid operations, and there may be other risks not known to me or not reasonably foreseeable to me at this time. In addition, I understand that as a participant in the Program/Activity events, I will engage in physical activities, riding, competing, practicing, training, observing, and competing in Program/Activity events, during which I could sustain serious personal injuries, illness (including communicable diseases), property damage, or even death as a consequence of not only Centenary University’s actions or inactions but also the actions, inactions, negligence or fault of others, conditions of the equipment used, facility conditions, weather conditions, negligent first aid operations and procedures and I understand that there may be other risks not known to me or not reasonably foreseeable at this time. I further understand and agree that any injury, illness (including communicable diseases), property damage, disability, or death that I may sustain by any means is my sole responsibility except for those occurrences due to the CENTENARY University’s negligence or intentional acts. RELEASE AND WAIVER OF LIABILITY: I, on behalf of myself, my personal representatives, heirs, executors, administrators, agents, and assigns, HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Centenary University, Its governing board, directors, officers, employers, agents, volunteers, and any students (hereinafter referred to as “Releases”) for any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgements of any and every kind (including attorneys’ fees), arising from any injury, illness (including communicable diseases), property damage or death that I may suffer as a result of my own negligent acts. ASSUMPTION OF RISK: Under New Jersey law, a participant and spectator are deemed to assume the inherent risks of equine animal activities created by equine animals, weather conditions, conditions of trails, riding rings, training tracks, equestrians, and all other inherent conditions. Each participant is assumed to know the range of his or her ability and it shall be the duty of each participant to conduct himself or herself within the limits of such ability to maintain control of the equine animal and to refrain from acting in a manner which may cause or contribute to the injury of the participant or others, loss or damage to person or property, or death which results from the participation in an equine animal activity. WARNING: UNDER NEW JERSEY LAW, AN EQUESTRIAN AREA OPERATOR IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ANIMAL ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ANIMAL ACTIVITIES, PURSUANT TO P.L. 1997, c.287 (C:5:15-1 et seq.) (“New Jersey Equestrian Law”). I understand that there are potential dangers incidental to my participation in the Program/Activity, some of which may be dangerous and which may expose me to the risk of personal injuries, property damage, or even death. I understand that these potential risks are including but not limited to activities such as, riding, practicing, training, competing, observing, traveling to and from Program/Activity site via private vehicle, common carrier, and/or University owner vehicle, injuries due to the behavior of the equine animals, condition of equipment, weather conditions, facility conditions, wildlife, negligent first aid operations of Releases, and other risks that are unknown at this time. In addition, I understand that there are risks attendant to physical activities and that there are potential dangers which may expose me to the risk of personal injuries, property damage, or even death. I am aware that the Program/Activity can be a vigorous activity involving severe cardiovascular stress and/or violent physical contact. I understand that Program/Activity activities involve certain risks, including but not limited to, death, serious neck and spinal injuries resulting in complete or partial paralysis, brain damages, and serious injury to virtually all bones, joints, muscles, and internal organs, and that protective equipment may be inadequate to prevent serious injury. I further understand that Program/Activity involves a particularly high risk of knee, head, and neck injury. In addition, I understand that participation in the Program/Activity involves activities incidental thereto, including, but not limited to, travel to and from the site of the activity, participation at sites that may be remote from available medical assistance, and the possible reckless conduct of other participants. I understand that these potential risks include, but are not limited to; travel to and from Centenary University, via private vehicles, common carriers, and/or Centenary University owned vehicles, or local transportation, behavior of the equine animals, weather conditions, facility conditions, equipment conditions, negligent first aid operations or procedures of Releases, and other risks that are unknown at this time. I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, and assume full responsibility for my participation in the Program/Activity. INDEMNITY: I, on behalf of myself, my personal representatives, heirs, executors, administrators, agents, and assigns, agree to hold harmless, defend and indemnify the Releases from any and all liability, including any and all claims; demands, causes of action (known or unknown), suits, or judgements of any and every kind (including attorneys’ fees), arising from any injury, property damage or death that I may suffer as a result of my participation in the Program/Activity, except to the extent the Releasee is liable under the New Jersey Equine Law. PERSONAL MEDICAL INSURANCE: I agree to purchase and maintain during the term of the Program/Activity personal medical insurance. I further acknowledge that I am responsible for the cost of any and all medical and health services I may require as a result of participating in the Program/Activity. CERTIFICATION OF FITNESS TO PARTICIPATE: I attest that I am physically and mentally fit to participate in the Program/Activity and I do not have any medical record of history that could be aggravated by my participation in my particular sport. MEDICAL CONSENT: I understand and agree that the Releases may not have medical personnel available at the location of the Program/Activity. In the event of any medical emergency, I authorize and consent to the University contacting emergency and/or medical personnel and to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care that may be deemed necessary for my safety and protection. I understand and agree that Releases assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment. CHOICE OF LAW: I hereby agree that this Agreement shall be construed in accordance with the laws of the State of New Jersey. SEVERABILITY: If any term or provision of this Agreement shall be held illegal, unenforceable, or in conflict with any law governing this Agreement the validity of the remaining portions shall not be affected thereby. I HAVE READ THIS AGREEMENT AND FULLY UNDERSTANDITS TERMS. I AM AWARE THAT THIS AGREEMENT INCLUDES A RELEASE AND WAIVER OF LIABILITY, AND ASSUMPTION OF RISK, AND AN AGREEMENT TO INDEMNIFY THE RELEASEES. I UNDERSTAND I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGREEMENT, AND SIGN IT FREELY AND VOLUNTARITY WITHOUT ANY INDUCEMENT. BY MY SIGNATURE I REPRESENT THAT I AM AT LEASE EIGHTEEN YEARS OF AGE OR, IF NOT, THAT I HAVE THE SIGNATURE OF MY PARENT OR GUARDIAN AS WELL AS MY OWN

I accept the release of liability *

Confidentiality

I understand that all information (written and verbal) about participants at Therapeutic Riding At Centenary is confidential and will not be shared with anyone without the express written consent of the participant and his/her parent/legal guardian. I further understand that I should not photograph participants.

I accept the confidentiality release *

Background Check Release

At Therapeutic Riding At Centenary, we require a Background Check for our Volunteers.

I hereby grant Therapeutic Riding At Centenary permission to run a background check *

Consent to Electronic Signature

I consent to electronically sign this document and acknowledge: 1. I have the right to have any document provided in paper or non-electronic form. [If you want a paper copy of any document, please click the “Export to PDF” link on any electronic form, save it to your computer, and print to sign, or reach out to a TRAC staff member to request a PDF.] 2. I have the right to withdraw my consent to sign electronic documents with electronic signature by contacting Centenary University/TRAC through the Contact Us link on our website. The legal validity and enforceability of the electronic documents, signatures and deliveries used prior to withdrawal of consent will not be affected. 3. Minimum Hardware and Software Requirements: To access (open and read) and retain (save) the electronic documents, I may be required to have certain hardware and software including, but not limited to, access to an email address, a computer/tablet/mobile device with Internet or mobile connectivity and sufficient storage to save and/or print, and a current web browser that includes 128-bit encryption. 4. By completing this consent, I acknowledge that I can access and retain electronic documents by printing out a copy of this document. 5. I hereby understand that if I do not wish to use the electronic signature option, I may print out the document(s), sign by hand, and mail them to TRAC Program, C/O Centenary University, 400 Jefferson Street, Hackettstown, New Jersey, 07840.

I consent to Electronic Signature *

TRAC personnel will be in touch to discuss the next steps of your volunteer application process, which includes a mandatory background screening for volunteers age 18 and over. There is no fee for completing your background screening.

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