Volunteer Registration Form
Welcome to SPIRIT Team. You are important to our organization, and we are thankful that you choose to support SPIRIT with your time and energy. Please take time to fill out and submit this form to help us learn about you to work together.
SPIRIT Team in action :)
General Information
Full Name (First AND Last) *
Your answer
Age *
Your answer
Date of birth *
MM
/
DD
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YYYY
Complete Address (Including zip code) *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Work Phone
Your answer
Email *
Your answer
Parent(s) name, if under 18
Your answer
Occupation *
Your answer
Employer/School *
Your answer
Health Information
Date of last tetanus shot
MM
/
DD
/
YYYY
Tuberculosis test (PPD) *
Date of test
MM
/
DD
/
YYYY
Do you require an Epi-Pen or Inhaler? *
Do you carry it with you? (If you don't have an Epi-Pen or Inhaler, select "No'") *
Special needs (If none, use N/A) *
Your answer
Please describe your current health status, particularly regarding the physical/emotional demands of working in a therapeutic riding program. Volunteer activities may include walking for extended periods of time, jogging short distances, working in hot/humid/cold conditions: therefore, address fitness, cardiac, respiratory, bone or joint function, recent hospitalizations/surgeries, or lifestyle changes. *
Your answer
Interest and Availability
How did you learn about Spirit? *
Your answer
For how long are you available (or no end date)? *
Your answer
In which areas are you interested? *
Required
What days and times are you available?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Program work with horses and children (Mon - Thu evenings; Sat mornings
Farm and barn care and maintenance (Mon - Sat mornings)
Fundraising and public relations
Board of Directors
Office Work
Background Information
Have you ever been charged or convicted of a crime? *
If yes, please explain (If no, use N/A): *
Your answer
*
Required
Authorization for Emergency Medical Treatment
In the event I am unconscious and unable to act for myself, please contact: *
Your answer
Relationship *
Your answer
Phone *
Your answer
In the event emergency medical aid/treatment is required, due to illness or injury, during the course of volunteering for the Spirit Open Equestrian Program Inc., either on said center site or with an off-site activity, I hereby authorize the Spirit Open Equestrian Program Inc. to:
This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed "life saving" by the physician. The provision will only be invoked if the emergency contact is unable to be reached.
In an effort to provide the best care possible, please indicate below if any of the following apply:
I am allergic to the following:
Your answer
I have the following ongoing medical conditions:
Your answer
I have been treated, recently, for the following physical/mental conditions:
Your answer
I am on the following medications:
Your answer
Confidentiality Policy
Due to the nature of therapeutic horseback riding, it is the policy of the Spirit Open Equestrian Program Inc. that any and all information pertaining to our riders, their family and volunteers shall remain privileged and confidential. This information may include, but is not limited to, any medical, social, referral, personal and/or financial information that may be disclosed as a result of participation at the center.

Disclosures of any confidential information shall not be released to anyone not associated with Spirit Open Equestrian Program Inc. Discussions involving any rider shall be limited to progress reports, appropriate mounted and unmounted safety guidelines and any other guidelines the instructor may deem appropriate in each situation. Volunteers will be given information concerning students on a "need to know" basis and in keeping with the confidential nature of our client's records. Each rider shall be assured of record confidentiality and as such, only authorized staff will have access to the secure records location. Volunteers are not permitted to discuss riders with other volunteers, their parents or guardians, other instructors, friends, etc., outside of the center.

Interviews or other forms of public discussions with any public relations media, either through television, radio or any other type of publications is strictly prohibited by any volunteer. All such matters should be directed to the Program Director for appropriate action. Since our intentions are to safeguard our riders, this policy is designed to ensure that the privacy of our riders, their families and volunteers is protected. Sensitive medical, psychiatric, psychological and/or personal information may be detrimental, if released to those outside of the Spirit Open Equestrian Program Inc. Such a breach of confidentiality may also constitute grounds for legal action.

Failure to adhere to Spirit Open Equestrian Program Inc. confidentiality policy, by any staff or volunteer, may result in the termination of service with the center. Corrective actions will be taken.

I agree to uphold the confidentiality policy as stated above.

Participant Signature
Your answer
Parent/guardian signature, if under 18
Your answer
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