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Dreams Go On

Volunteer Form

Please Print all Information                                                                                                                                           Date: ____________

Name: ____________________________________

Address:___________________________   City________________   Zip:______________

Birthdate:_______________  Height______________

Phone:_________________  Cell:___________________ Work:_______________________

Email:_______________________________________

Do we permission to use your photo in press releases for promotional purposes?  Y  or  N

Volunteer positions would you like to serve in?  ________Side-Walker ______Horse Leader ______Fundraising 

What experience do you have 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?_____________________________________________

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:_____________

PA Equine Liability Law: “You assume the risk of equine activities pursuant to Pennsylvania Law.2005

Dreams Go On, Inc.

A Therapeutic Horseback Riding Facility

I, _________________________________________ Volunteer, accept all responsibility for any personal accidents, injury or theft incurred while volunteering with Dreams Go On, Inc. therapeutic horseback riding program.   

The signee is also hereby informed that all aspects of riding and un-mounted instruction can be dangerous and that there is always a potential danger when in the company of horses.

The signee promises to abide by all safety rules set by Dreams Go, Inc. and the Instructors appointed by this organization. The signee acknowledges that this release form concerns only the signee and will hold no fault against Dreams Go On, Inc., our office or the stable where or instruction occurs.

I accept the above condition before beginning volunteering with Dreams Go On, Inc.

_________________________________________________________          _______________

           Signature of Volunteer or Parent of Volunteer                                                Date

Vol/smk 3/08