I would like to participate as a volunteer in the High Hurdles Therapeutic Riding Program. As a volunteer at Suburban Adult Services, Inc. (SASi) / High Hurdles Therapeutic Riding Program and LTRC, I acknowledge the risks and potential for risks of a horseback riding program which include without limitation falling, getting injured by the animals and getting injured assisting participants. I accept all risks. My participation is voluntary. The High Hurdles Therapeutic Riding Program/LTRC does not provide supports or supervision I or the person I am assisting may otherwise need thus I am always responsible for all my support needs or supervision I may require thus I am always responsible for all my support needs and protections while at the program. I understand the High Hurdles Therapeutic Riding Program/LTRC has not made any assessment of my physical or emotional ability to participate as a volunteer and I am presenting myself as fit to participate. I will also educate myself on safety procedures. I feel that the benefits to myself/my son/my daughter/my ward and the people I support 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 sasi/LTRC, their Board of Directors, Instructors, Therapists, other Volunteers and/or employees for any and all injuries and/or losses I/my son/my daughter/ my ward may sustain while participating as a volunteer in the sasi High Hurdles Therapeutic Riding Program and/or Lothlorien Therapeutic Riding Program. I authorize sasi/LTRC to verify any information I have furnished in this application and to contact any references I have including employers. In doing so I release sasi/LTRC and employer on reference from any liability in release of this information. I affirm that I have read this completed application and have not withheld any information or response to any questions, and that the information I have furnished is true and correct. I understand that discovery of any misrepresentation or omission of facts can be grounds for rejection of application or for immediate dismissal, regardless of when such misrepresentation or omission is discovered. This application form is intended for use in evaluating your qualifications for an internship or volunteer position. This is not an employment contract. Completion of this application is in no way a guarantee of an interview or an offer of a position. False or misleading statements during the interview or on this form are grounds for terminating the application process, or if discovered after, terminating the internship or volunteer position.

Please be considerate of a rider’s right to privacy both at High Hurdles/LTRC and when you leave. Information regarding rider identity and disability should never be discussed outside of High Hurdles/LTRC. Health, medical and other sensitive information will be given on an “as needed” basis with the consent of the rider and/or parents/guardians. High Hurdles/LTRC staff are not permitted to disclose a rider’s disability or diagnosis, but may share other information that will ensure the safety of the horse, rider and staff during their lessons. Please do not seek this information from riders, families and caregivers. This is both to respect our participants and to be in compliance with federal HIPAA laws.

At High Hurdles, we require a Background Check for our Volunteers.

I consent to the use of electronic signatures for the purposes of this application and all other documentation involved with High Hurdles/LTRC communications.

High Hurdles/LTRC will be in contact to conduct a brief phone interview and obtain 2 personal or professional references. Please be on the lookout for a call from us!