Volunteer Registration Form
Welcome to the SPIRIT team! You are important to our organization and we are thankful that you have chosen to support SPIRIT with your time and energy. Please fill out and submit this form so we can learn more about you.

Please be aware: SPIRIT can not accept people with any kind of mental or developmental disturbances due to safety reasons.
COVID 19 Policies
Precautions for a reopening SPIRIT
Paticipants, Volunteers, Staff
SPIRIT will adhere to federal, state, county and FCPS regulations or guidelines.
Centers for Disease Control (CDC) guidelines:
• Shelter-in-place/quarantine mandates/guidelines
• Wearing of facial masks
• Maintaining social distancing guidelines
• Following gathering size guidelines
These regulations or guidelines can be found on Protect Yourself & Slow the Spread of COVID-19 | Health
Consideration for Therapeutic Riding Program Participants
A disability alone may not be related to higher risk for getting COVID-19 or having severe illness. Most people with disabilities are not inherently at higher risk for becoming infected with or having severe illness from COVID-19. However, some people with disabilities might be at a higher risk of infection or severe illness because of underlying medical conditions. All people seem to be at higher risk of severe illness from COVID-19 if they have serious underlying chronic medical conditions. Adults with disabilities are three times more likely than adults without disabilities to have heart disease, stroke, diabetes or cancer.
Link for high risk conditions: https://www.cdc.gov/coronavirus/2019-ncov/hcp/underlying-conditions.html Link for information from CDC on disabilities and COVID-19: https://www.cdc.gov/coronavirus/2019-ncov/need-extra- precautions/people-with-disabilities.html

We have prepared our work areas according to the CDC recommendations by reducing transmission among employees, maintaining healthy business operations and maintaining a healthy work environment.
• Anyone coming onto the property who is sick or has someone in the household who is sick should stay home or reschedule. This includes employees, volunteers, participants and their caregivers.
• SPIRIT encourages frequent hand washing; at the hand wash station in the barn, or at Park restrooms. If soap and water are not readily available, we shall provide alcohol or bleach-based spray sanitizer for all students, volunteers, staff members
• Posters that encourage hand hygiene to help stop the spread will be placed at the entrance to our gathering areas
• Handshaking, hugs are not acceptable, we encourage the use of other non contact methods of greeting.
• Routine environmental cleaning and disinfection:
o Routinely cleaning and disinfecting all frequently touched surfaces, such as workstations, keyboards, telephones, handrails, doorknobs, stall doors, tack and other commonly used equipment.
o If surfaces are dirty, they should be cleaned using a detergent or soap and water if available or disinfectant spray
o Discouraging all from using other’s’ phones, desks, offices, or other work tools and
equipment, when possible. If necessary, clean and disinfect them before and after use.
o Providing disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks, other work tools and equipment)should be wiped down by staff/volunteers before each use.

* General rules of social interaction during the pandemic issued by public health authorities, local, state and federal government and Fairfax County Park Authority are automatically mandatory rules at SPIRIT
* All enclosed areas at SPIRIT Farm Operational site (Feed room, Tackroom, Office, stalls) have one person limit until further decisions
* size of the class or group will be limited according actual recommendation
* a physical distance of 6 or more ft, is mandatory while working in the barn area or in the program, except lessons with riders who require full "hands on support".
* face covering and gloves are mandatory for any group activity when distance is less than 20 ft
* if student/volunteer/staff or anyone in their household do not feel well, have a fever or other symptoms of COVID 19 infection, should not come on site and and it is mandatory to notify SPIRIT Office about it
*Instructor, therapist, assistant or assigned volunteer will keep track of any personal contact, as well as attendance of program activities, and make it available to authorities for tracking purpose
* Instructor, therapist, assistant or assigned volunteer will organize and supervise prior, between and after classes- disinfection of gates, doors, restroom, feed room, tackroom, office and all items used for activities (helmets, vests, grooming kits, toys), and control temperature of all attendees using no contact thermometer
* hands of all on site should be washed/wiped/sprayed at least before, in between and after each class, and staff/senior volunteers will supervise and encourage that policy
* mounting procedure should be done with not more than 3 people (Instructor, horse manager, one side walker)
* students who require "hands on" support will have one volunteer provided by family from the own household
*SPIRIT will provide training for parent/caregiver/sibling (over 14 years old) to safe support student who needs full support during the session

SPIRIT encourages everyone on site to provide their own PPE when on site, but will have some rady for essential volunteers/staff/visitors/students as needed.

• Communication with the participant, parent or caregiver prior to a session to:
o Verify that there are no underlying health issues that would go against any shelter-in-place mandates.
o Ask if the participant or anyone within their household do not have symptoms present, such as a fever or cough.
o Explain how the center is monitoring the health of the staff.
o Explain how the center is cleaning AND disinfecting equipment and common areas.
o Explain what they can expect when they arrive, such as hand washing expectations or wearing of masks.
o Explain how social distancing is going to work within the session or what alternative activities are
available.

I fully understand and agree to follow these and any future policies and procedures during a program activity.


Full Name *
Age - We accept only volunteers over the age of 14. Tell us in which group you belong *
Date of birth *
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Address *
Home Phone
Cell Phone
Work Phone
Email *
Parent(s) name, if under 18
Occupation
Employer/School
Health Information
Special needs *
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. *
Required
Interest and Availability
How did you learn about Spirit? *
For how long are you available ? *
Required
Which area(s) are you interested in? *
Required
What day(s) and time(s) are you available? *
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
AM 9-12
PM 5-8
From home
As needed
Background Information
Have you ever been charged or convicted of a crime? *
If yes, please explain:
Authorization for Emergency Medical Treatment
In the event I am unconscious and unable to act for myself, please contact: *
Relationship *
Phone *
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:
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.
Verification of electronic signature *
Required
Signature *
Signature Name of parent/guardian, if under 18
Date
MM
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