Red River Riders Therapeutic Horseback Riding, Inc.
N6669 Cherry Road, Shawano, WI 54166
715-526-6400 715-853-6449 (cell)
www.redriverriders.org
Volunteer Registration and Questionnaire
Name: ______
Today’s Date: ______DOB (Optional if over 18): ______
Street Address: ______
City: ______State: _____ Zip: ______
Home Phone: ______Cell or Work Phone: ______
E-mail Address: ______
If you are volunteering for graduation requirements or job credit, please briefly explain the program in which you are involved, and provide the Volunteer Coordinator(s) with any additional paperwork that needs to be completed. ______
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Do you have any prior experience working with horses? Please briefly explain. ______
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Do you have any previous experience working with individuals with mental, physical, or emotional disabilities? Please briefly explain. ______
What are your interests, hobbies, and professional skills? We are always finding new ways to make your volunteering experience optimally rewarding for you and optimally useful to us. ______
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Are there any jobs you do not wish do to? ______
How did you find out about our organization? ______
Do you have any additional comments or questions? ______
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Emergency Medical Information
No person will be accepted for volunteering at Red River Riders until this form has been completed by the individual, if over 18, or a parent or guardian, if under 18, and returned to the Volunteer Coordinator(s).
Volunteer’s name: ______
Parent or Guardian if under 18: ______
Daytime phone, if different from previous page: ______
Emergency Contact: ______Phone: ______
Relation to Volunteer: ______
- or -
Person who is authorized to give temporary assistance or care in absence or parent or guardian:
Name: ______Phone: ______
Health Insurance Company: ______Policy #: ______
Do you have any allergies? ______
Do you have and medical conditions requiring special precautions or treatment? ______
Physician’s name: ______
Phone: ______
Preferred Medical Facility: ______
In case of medical emergency, the undersigned authorizes Red River Riders to provide such medical assistance as they determine to be necessary. The undersigned authorizes any licensed physician and/or medical facility to provide any medical/surgical care and/or hospitalization for the volunteer, including anesthetic, which they determine necessary or advisable, pending receipt of a special consent form from the undersigned.
No liability can be accepted by any of the organizations concerned including Red River Riders.
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Volunteer Signature (if over 18) Date
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Parent or Guardian Signature (if under 18) Date
Liability Release
I, ______would like to participate at Red River Riders as a volunteer. I acknowledge that there are inherent risks and potential for injury when working around and riding horses. I agree to be legally bound for myself (or my son or daughter, if volunteer is under 18) and hold Red River Riders, its Board of Directors, instructors, therapists, aids, students, employees, and volunteers, and the township of Richmond, its employees, supervisors, and associates harmless of any claim for damages, loss, or injury while at the Red River Riders facility located at N6669 Cherry Road, Shawano, WI, or while off the property in conjunction with Red River Riders.
Volunteer Signature ______(if over 18) Date
Parent or Guardian Signature______(if under 18) Date
Confidentiality Release
Red River Riders shall preserve and respect the right of confidentiality for all individuals in our therapeutic riding and driving program. The volunteers and staff of Red River Riders must keep confidential any and all medical, social, referral, personal, and financial information regarding individuals and their families in our program. The Director of the program will address any breach of confidentiality.
I, ______, understand and agree to abide by the confidentiality policy of Red River Riders.
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Volunteer Signature (if over 18)
Date ______
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Parent or Guardian Signature (if under 18)
Date ______
Photo Release
Red River Riders uses photographs and audio-visual materials for promotional purposes, teaching seminars, and exhibition display.
If you consent to having yourself (or your son or daughter, if volunteer is under 18) included in our photographs and audio-visual materials, please sign below.
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Volunteer Signature (if over 18)
Date ______
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Parent or Guardian Signature (if under 18)
Date ______
Background Information Release
Have you ever been charged with or convicted of a crime? Y or N: Please explain
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I, ______(volunteer/staff), authorize Red River Riders to receive information from any law enforcement agency, including police departments and sheriff’s departments, of this state or any other state or federal government, to the extent permitted by state and federal law, pertaining to any convictions I may have had for violations of state or federal criminal laws, including but not limited to convictions for crimes committed upon children.
I understand that such access is for the purpose of considering my application as a volunteer, and that I expressly DO NOT authorize Red River Riders, its directors, officers, employees, or other volunteers to disseminate this information in any way to any other individual, group, agency, organization, or corporation.
SIGNATURE: ______DATE______
CURRENT DRIVERS LICENSE Y/N LICENSE
NUMBER______STATE______
2017 RRR Farm Rules
SAFETY FIRST – All riders and volunteers need to follow some safety rules to keep all participants safe. Please read through these rules, ask questions, and then sign below. Thanks you.
NO SMOKING ANYWHERE ON THE FARM!
DRIVE SLOWLY!
In order to prevent liability issues, please do not arrive at the farm more that 30 minutes before the first class of the day.
If you have not been trained to catch the horses in the pasture or paddocks, please do not go in the pasture or paddocks without supervision by an instructor.
Parents must supervise all children who are not participating in a class.
No running, shouting, playing directly around the arena or mounting area.
Cell phones MUST be turned off during classes. Chris, Dawn, Jennifer, & Carrie will have cell phones available for emergencies. If you MUST make or receive a call, DO NOT leave your rider until someone has taken your place.
CLOTHING: No halter tops, crop tops, tube tops, tops with spaghetti straps, swim suit, etc.
No extremely loose fitting clothes, or pants that are dragging on the ground.
No sandals, shoes with excessive heels, or slip-on shoes.
Sneakers are fine, work boots or riding boots are best.
No wind pants. Jeans are best.
No one will be allowed to ride in shorts.
No dangling jewelry – it may catch on saddles, helmets, etc, or riders may grab and pull.
If you use something – please put it away properly & in the same place you found it.
Help us keep the farm clean – pick up all garbage, candy wrappers, straw papers, anything that is dropped. Recycle bottles and pop cans.
All manure must be picked up around the barn & arena – if you are grooming a horse & he/she drops manure you are responsible for picking it up.
Instructors need to be aware of any serious medical conditions including, but not limited to: pregnancy, epilepsy, heart problems, diabetes, etc. Please discuss privately with instructors.
THANK YOU – your help will keep everyone safe and the farm clean.
I have read and understand the above rules. I agree to follow the rules listed above. Volunteer, Rider, Caregiver, Parent, Guardian (please circle one)
Signature: ______
Name ______(print)Date:______