Tri-State Therapeutic Riding Center

PERSONAL INFORMATION

All TSTRC Volunteers are required to read the Volunteer Handbook found in "FORMS" on our website. Please check to confirm that you have reviewed it.

Emergency Contact Information

If you are UNDER AGE 18, please complete this section

Health Information

Please list any allergies or conditions that may affect you during the time at which you are volunteering: (Easily fatigued, asthma, allergic to bee stings, any major surgeries or conditions that EMS would need to be notified of in the event of an emergency) 

VOLUNTEER EXPERIENCE

VOLUNTEER PREFERENCES

Please check all areas you would be interested in helping with

Preferred Schedule

AUTHORIZATIONS AND CONSENT AGREEMENTS

Authorization for Emergency Medical Treatment 

I understand that all information (written and verbal) about participants at TSTRC is confidential and will not be shared with anyone without the expressed written consent of the participant and their parent/guardian in the case of a minor. This includes all medical, social, referral, personal, financial, and otherwise sensitive information. I understand that individuals who breach confidentiality will be removed from the TSTRC program. 

Confidentiality Agreement 

I understand that all information (written and verbal) about participants at TSTRC is confidential and will not be shared with anyone without the expressed written consent of the participant and their parent/guardian in the case of a minor. This includes all medical, social, referral, personal, financial, and otherwise sensitive information. I understand that individuals who breach confidentiality will be removed from the TSTRC program. 

Photography Consent

I understand that TSTRC often takes still pictures and/or videos of students, clients, volunteers and instructors for a variety of reasons. I authorize TSTRC to take still and/or video photographs of myself, or the individual for which I am legally responsible.

Background Information Consent

Have you ever been charged with or convicted of a crime? (We ask this because of requirements for organizations working with people with disabilities and children.)

• If answering "yes" above, please complete following consent:

I consent to authorize TSTRC to receive all information from any law enforcement agency, including police departments and sheriff’s departments, of any state or federal government, to the extent permitted by state and federal law, pertaining to any convictions I may have had, including but not limited to crimes committed upon children or animals. I understand that such access is for the purpose of considering my application as a volunteer, and that I expressly DO NOT authorize TSTRC, its directors, officers, employees, or other volunteers to disseminate this information in any way to any individual, group, agency, organization, or corporation. 

Liability Waiver

To be completed by the adult participant, participant’s parent, or participant’s legal representative. 

This release of liability is made and entered into on the date noted by this applicant and between Tri-State Therapeutic Riding Center, hereinafter known as TSTRC, and staff/participant/volunteer as noted below, hereinafter known as participant, and if a minor or dependent adult, that participant’s parent, legal guardian, or legal representative as noted below. In return for participation in TSTRC’s therapeutic horseback riding activities, special events and fundraisers, the participant, his/her heirs, assigns, and legal representatives hereby expressly agree to the following: 

1. Participant agrees to assume any and all risks involved in or arising from participant’s participation or presence upon the property and facilities, including, without limitation, but not limited to the risks of death, bodily injury, property damage, falls, kicks, bites, collisions with vehicles, horses, or stationary objects, fire or explosion, the unavailability of emergency medical care, or the negligence or deliberate act of another person. 

2. Participant agrees to hold TSTRC and all of its successors, assigns, subsidiaries, franchisee, affiliates, officers, directors, employees, agents, and boarders completely harmless and not liable and release them from all liability whatsoever and agrees not to sue them on account of or in connection with any claims, causes of action, injuries, damages, costs or expenses arising out of participant’s participation and/or presence upon TSTRC’s property and facilities, including without limitation, those based on death, bodily injury, property damage, including consequential damages, except if the damages are caused by the direct willful and wanton negligence of TSTRC. 

3. Participant agrees to waive the protection afforded by any statue or law in any jurisdiction whose purpose, substance and/or effect is to provide that a general release shall not extend to claims, material, or otherwise, which the person giving the release does not know or suspect to exist at the time of executing the release. 

4. Participant agrees to indemnify and defend TSTRC against, and hold it harmless from, any and all claims, causes of action, damages, judgments, costs, or expenses, including attorney’s fees, which in any way arise from participant’s participation and/or presence upon TSTRC’s property or facilities. 

5. This contract is non-assignable and non-transferable and is made and entered into the State of Alabama and shall be enforced and interpreted under the laws of this state. Should there be any clause in conflict with State Law, then that clause is null and void. When TSTRC and participant or participant’s parent, legal guardian, or adult caregiver signs this contract, it will then be binding on both parties, subject to the above terms and conditions.