ManeGait Volunteer Application

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We're excited to have you join us! Please complete this form and press "Send" when you're done.

Contact Information

Full Name:

First Name

Last Name

Preferred Name (if different than First Name)

Email Address

Street Address

City

State

Zip

Home Phone Number:

Mobile Phone Number:

Work Phone Number:

Preferred Contact Method

Home PhoneMobile PhoneWork PhoneE-mail

By checking this box, you agree to receive text messages from ManeGait related to volunteering with ManeGait. Message & data rates may apply. Message frequency varies. Reply HELP for help and STOP to opt-out. View our Privacy Policy

Opt-in to text messages about volunteering

Date of Birth (MM/DD/YYYY)

If you're employed or go to school, please tell us where:

Are you under 18?

YesNo

Are you a Veteran or First Responder?

Yes

Parent / Gardian Name

Parent / Guardian Phone Number

How Did You Hear About ManeGait?

Please provide the details:

Skills

Experience working with horses:

Experience with people with disabilities:

Occupation: (check what most closely matches your occupation / skills)

If selected Considerable, please list experience below:

Sorority / Fraternity / Clubs / Affiliations:

Please list any Horse Associations / Clubs / Equestrian Centers you are involved in:

Medical Information

Emergency Contact Name:

Relationship:

Emergency Contact Home Phone Number:

Emergency Contact Mobile Phone Number:

Emergency Contact Work Phone Number:

Physician's Name:

Physician's Phone:

Allergies:

Date of Last Tetanus shot (MM/DD/YYYY):

Please indicate any disability, limitation or medical conditions that may affect your volunteer role and that we should be aware of:

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Medical Treatment Release

CONSENT: I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, any participation on my part at ManeGait, or while being on the property of ManeGait, I authorize ManeGait Therapeutic to: 1. Secure and retain medical treatment and transportation, if needed. 2. Release records upon request to the authorized individual or agency involved in the medical emergency treatment.NON-CONSENT: I do not give consent for emergency medical treatment/aid in the event of illness during the process of receiving services, any participation on my part at ManeGait, or while being on the property of ManeGait. In the event emergency treatment/aid is required, I wish the following procedures to take place

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Photo Consent

I consent to and authorize

I do not consent to nor do I authorize

the use and reproduction by ManeGait of any and all photographs and any other audiovisual materials taken of me or my child or family member for promotional printed material, educational activities, exhibitions, or for any other use for the benefit of the program.

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Policy of Confidentiality
I agree to respect and observe privacy and confidentiality of the participants, volunteers and donors of ManeGait Therapeutic Riding Center and not discuss or disclose any sensitive information about any person or their family.

Agree to Policy of ConfidentialityDo NOT Agree to Policy of Confidentiality

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ADULT LIABILITY RELEASE

I acknowledge the risks and potential for risks of horseback riding and working with horses, including but not limited to: falling or being thrown from a horse; being kicked, stepped on or bitten by a horse; hitting overhead objects; and/or injuries sustained while mounting or dismounting a horse. I further acknowledge the risks and potential for risks associated with recreational and outdoor activities, including but not limited to: snake, animal or insect bites; uneven ground; sun, cold and wind exposure; cuts and scrapes; sore or pulled muscles; broken, dislocated or fractured bones; nerve damage; internal injuries; head injuries; grievous bodily injury and death. However, I feel that the possible benefits to be offered at ManeGait are greater than the risks assumed. I hereby, intending to be legally bound for myself, my heirs, assigns, executors and administrators, waive and release forever all claims for damages against ManeGait Therapeutic Horsemanship, its directors, officers, landlord, agents, employees, clients, independent contractors and volunteers (collectively, “The Released Parties”) from any and all claims, demands and causes of action of any and every kind or nature including any and all injuries and/or losses I may sustain while participating in activities at or sponsored by ManeGait or while on ManeGait property, from whatever cause, including but not limited to the negligence of The Released Parties. I certify that I am 18 years of age or older and am fully competent to enter into this release. I have read this Release in its entirety. I understand the terms of this Release and have signed this Release voluntarily and with full knowledge of the effects thereof. The above information may be verified and I give permission to make inquiry of others, including a background check, concerning my suitability to act as a volunteer at ManeGait.

I have read the above and AGREE to the liability releaseI have read the above and DO NOT AGREE to the liability release

Driver's License Number

Driver License State

Have you been convicted of a criminal offense?

Explaination

LIABILITY RELEASE FOR A MINOR OR WARD

That I,

the undersigned, a parent/legal guardian of

I have read the above and AGREE to the liability release

for and in sole consideration of the privilege of permitting said person to participate in activities at or sponsored by ManeGait Therapeutic Horsemanship Center and recognizing that horse riding activities involve certain inherent dangers and risks to persons and property, do hereby agree to assume for myself and on behalf of my ward or child, the risks and dangers attendant to such activity, including but not limited to: falling or being thrown from a horse, being kicked, stepped on or bitten by a horse or other animal, and/or injuries sustained while riding, mounting or dismounting a horse. I further acknowledge the risks and potential for risks associated with recreational and outdoor activities, including but not limited to: snake, animal or insect bites; uneven ground; sun, cold and wind exposure; cuts and scrapes; sore or pulled muscles; broken, dislocated or fractured bones; nerve damage; internal injuries; head injuries; grievous bodily injury and death. I am aware of these and other risks associated with horse riding activities, however, I feel that the possible benefits to be offered by ManeGait are greater than the risks assumed. I hereby, intending to be legally bound for myself and my child/ward, heirs, assigns, executors and administrators, waive and release forever all claims for damages against ManeGait Therapeutic Horsemanship, its directors, officers, landlord, agents, employees, clients, independent contractors and volunteers (collectively, “The Released Parties”) including any and all injuries and/or losses I or my child/ward may sustain while participating in activities at ManeGait or while on ManeGait property, from whatever cause, including but not limited to the sole or contributory negligence of all or any of The Released Parties. I DO HEREBY FURTHER AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE RELEASED PARTIES FROM AND AGAINST ANY AND ALL CLAIMS, LOSSES, DAMAGES, CAUSES OF ACTION, ATTORNEY’S FEES AND EXPENSE OF LITIGATION FOR DEATH OR INJURY TO ANY PERSON OR FOR LOSS OF OR DAMAGE TO ANY PROPERTY ARISING OUT OF OR IN CONNECTION WITH MY CHILD/WARD’S PARTICIPATION IN ACTIVITIES AT OR SPONSORED BY MANEGAIT. IT IS MY EXPRESS INTENTION THAT THE INDEMNITY PROVIDED FOR IN THIS PARAGRAPH IS AGREED TO BY THE UNDERSIGNED IN ORDER TO FULLY INDEMNIFY AND PROTECT MANEGAIT FROM THE CONSEQUENCES OF THE RELEASED PARTIES’ OWN NEGLIGENCE, WHETHER THAT NEGLIGENCE IS THE SOLE OR CONTRIBUTING CAUSE OF INJURY, DEATH OR DAMAGE.

I have read the above and AGREE to the liability releaseI have read the above and DO NOT AGREE to the liability release

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Volunteer Code of Conduct

- I will honor our commitment to our riders.

- I realize that safety is of the utmost importance.

- I will take seriously the importance of confidentiality.

- I will respect my fellow volunteers.

- I will cooperate with the instructor and be open to their guidance.

- I will be compassionate and caring to our riders.

- I will treat the ManeGait horses humanely and with understanding, patience and care.

- I will help instill in our riders, empathy for the horse.

- I will help to maintain the integrity of ManeGait’s property, facilities and equipment.

- I will conduct myself in a wholesome and positive manner.

I have read and agree to ManeGait’s Volunteer Code of Conduct:

AgreeDisagree

Facility Maintenance	Fundraising	Horse Care
Hospitality	IT / Website	Photography / Video
Public Relations	Horse Leader / Side Walker	Schooler
Special Events	Volunteer Recruitment	Tack Cleaning