Name_____________________________Date_______________________

Address___________________________________________________

Birthdate________  Volunteers must be at least 16 years old.   Height_____

Phone_____________Cell #____________Work Phone # if cancellation__________

E-mail  ________________________________

Do we have permission to use your photo in press releases for promotional purposes?   YES______  NO________How would you like to serve as a volunteer:   __ Side-walker      __ Horse/pony leader    __ Fund-raising 

Our rides are held on Tuesday & Thursday evenings and Saturday mornings.  What times are you available to volunteer?

Tuesday or Thursday  First session:    ____ 5:30     Second Session:  ____ 6:00  Third Session:  ____ 6:30      Fourth Session:  ____ 7:00

Saturdays:  First session:    ____ 10:00     Second Session:  ____ 10:30  Third Session:  ____ 11:00     Fourth Session:  ____ 11:30

 What experience have you had with horses? _________________________________________________________

What experience have you had with persons with physical or mental challenges? _________________________________________________________

Do you have any physical limitations?______________________________   Have you been convicted of a felony in the last 10 years and if so what: ___________

I know and understand that working with and around horses as a volunteer has elements of risk.  I agree to attend on-site training to be able to do this work in a safe and responsible manner.

Signature______________________________  Date________                            THANK YOU!! 

Pennsylvania Equine Liability Law.  "You assume the risk of equine activities pursuant to Pennsylvania law  2005