Wranglr

Heartland Therapeutic Riding Volunteer Application

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

First Name *

Last Name *

Email *

Mobile *

Photo & Publicity Release

Volunteer (or Volunteer’s parents or legal guardians) hereby consent and authorize HTR to observe all of Volunteer’s activities on behalf of HTR, on or off premises, which can include taking photographs or motion pictures of Volunteer and Program Participants, and to produce videotapes, audiotapes, closed circuit television programs, web casts, or other types of media productions that capture Volunteer’s name, voice, and/or image (any of the foregoing types of media are called the “Materials” in this Consent and Release form). Observation of therapy sessions or volunteer work may include observation by guests of HTR who are taking a tour of the facility or engaging in other HTR authorized activities. Guests may include prospective volunteers, clients, donors, staff, and others interested in HTR. With this knowledge, Volunteer authorizes HTR to copyright the Materials, and to use, reuse, copy, publish, display, exhibit, reproduce, license to third parties, and distribute the Materials in any educational or promotional materials or other forms of media, which may include, but are not limited to therapeutic publications, catalogs, articles, magazines, recruiting brochures, websites, social media or publications, electronic or otherwise, without notifying me; and agree that HTR may identify me by name. Volunteer agrees that I am participating on a voluntary basis and will not receive any payment from HTR for signing this release or as a result of any use or publication of the Materials.

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 *

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

Important Information and Acceptances

General Liability Release

I understand that as a volunteer at Heartland Therapeutic Riding, Inc. (hereinafter “HTR”), I will be working around horses in a barn environment. I have read and understand the following statutory warning about the risks inherent in equine activities: KANSAS DOMESTIC ANIMAL LIABILITY ACT WARNING “Under Kansas law, there is no liability for an injury to or the death of a participant in domestic animal activities resulting from the inherent risks of domestic animal activities, pursuant to sections 1 through 4. You are assuming the risk of participating in this domestic animal activity. Inherent risks of domestic animal activities include, but shall not be limited to: (1) The propensity of a domesticated animal to behave in ways, i.e. running, bucking, biting, kicking, shying, stumbling, rearing, falling or stepping on, that may result in an injury, harm or death to persons on or around them; (2) the unpredictability of a domestic animal’s reaction to such things as sounds, sudden movement and unfamiliar objects, persons, or other animals; (3) certain hazards such as surface and subsurface conditions; (4) collisions with other domestic animals or objects; and (5) the potential of a participant to act in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the domestic animal or not acting within such participant’s ability.” K.S.A. §60-4002 et. seq. (1994) Liability Release: Volunteer (or Parent/Legal Guardian if Volunteer is a Minor) acknowledges the risks and potential for risks in involvement and participating in equine activities; understands that despite all precautions taken by HTR, equine activities are by their inherent nature “high risk” activities, and horses as natural prey animals may instinctively resort to unpredictable equine behavior despite all care taken by HTR. Volunteer, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever and will bring no litigation, suit or claims of any kind for damage or otherwise, including but not limited to personal injury or property damage, against Heartland Therapeutic Riding, Inc., its Board of Directors, Officers, Instructors, Therapists, Aides, Volunteers and/or Employees (hereinafter collectively “the Released Parties”), for any and all injuries and/or losses of any kind I / my child/my ward may sustain while participating in any function sponsored by or held at Heartland Therapeutic Riding, Inc.’s premises, and/or HTR sponsored activities held off premises, even for claims arising from the alleged negligent acts or omissions of the Released Parties.

I accept the release of liability *

Confidentiality

I understand that all information (written and verbal) about participants at HTR is confidential and will not be shared with anyone without the expressed written consent of the participant and his/her parent/guardian in the case of a minor. I have received an understand the policies and regulations as presented in the HTR Volunteer Handbook, including the Child and Vulnerable Adult Protection Policy. Furthermore, I understand that failure to abide by HTR’s policies and regulations may result in termination from my volunteer position.

I accept the confidentiality release *

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