Volunteer Registration and Release Form

High Hopes Registration Form










Participant Intro
Thank you for your interest in participating at High Hopes! All participants MUST complete:

1. This registration

Therapeutic Riding and Carriage Driving participants MUST also complete:

2. Physician's Statement (download here)

**The Physician's Statement is optional for those participating only in our Equine Learning Program and/or Community Lessons, unless otherwise requested by High Hopes staff.

If the participant receives OT/PT and/or mental health services, you may also provide:
Primary Contact Info
Please enter information for the parent, guardian, staff or representative who is completing this form.























Please complete the remainder of the form with the prospective participant's/volunteer's information. Thank you!

Participant Information


Volunteer Information









Accurate participant weight reporting is essential for appropriate horse matches. Our maximum riding weight limit is 180lbs. Please round to the nearest whole number, in pounds, i.e. "145".

For Volunteer or Summer Camp Tee Shirts


Contact Information











Don't have an email? This field is required, so type none@none.com.









Many grants that help offset participant fees are based on the participant's residence location. Even if they will not receive mailing there, please let us know the town and county of their residence.


Legal Guardian, Billing & Transportation Contact Info
Legal Guardian Info
Please indicate who the participant's Legal Guardian is.


Provide the Legal Guardian's full name and best contact info (e.g. phone or email). Limit 255 characters.

Billing Contact Information























Transportation Info
You can leave this blank if the participant will transport themselves, be transported by the Primary Contact listed above, or you're not sure of this info yet.








If you have no allergies, please enter "none" or "nka".

Volunteer Registration


Occupation


Does your employer offer volunteer benefits?
Volunteer Interests



Participant Registration






Seizure Info

Leave blank if unknown.




Pertinent information may include things like: temperature or light sensitivity, g-tubes, tactile defensiveness, sensory aversions, fatigue, high or low pain tolerance, self-stimulatory behaviors, etc




Tell us about you!

Tell us more about your characteristics and abilities. This will help us match you with the right program and team for your goals. 









Availability
Please tell us the days and time periods you are available to volunteer on a weekly basis. Your actual volunteer schedule will be arranged with the Volunteer Manager following your Training and Orientation session.
Please tell us the semesters, days and times you are available. Your actual schedule will be arranged with staff after your New Participant Assessment.
Available Semesters (Please indicate YES, for all that apply)
School Year
Opt Out of Winter only if you have a medical condition or transportation concern that would prohibit you from participating in colder months (Jan-Feb).
Afternoons and Evenings
Mornings
Available Days (Please indicate YES, for all that apply)
Available Times (Please indicate YES, for all that apply)

Let us know if you have specific preferred (or unavailable) days & times.
Background Check Information (over 18)
Background Check and Personal References are required for those 18 years old and over.







Please read and sign the following statements.

Authorization for Emergency Medical Treatment
In the event emergency medical aid/treatment is required due to illness or injury while being on the property of the agency, I authorize High Hopes to secure and retain medical treatment and transportation, if needed, and release records upon request to the authorized individual or agency involved in emergency medical treatment.  

If applicant is under 18 years of age, parent/guardian signature is required.

Photo, Video, and Publicity Release

By engaging in activities at High Hopes Therapeutic Riding, Inc. I understand that I/my child/my ward may be photographed, filmed, or videotaped and I hereby give High Hopes Therapeutic Riding, Inc. the unqualified right to take pictures and/or recordings of me/my child/my ward and grant the perpetual right to use that likeness, video, image, photograph (collectively “image”), without compensation, for broadcast or exhibition in any medium and to put the finished images/recordings to any legitimate use without limitation or reservation. I hereby waive, release and forever discharge High Hopes Therapeutic Riding, Inc. from and against any and all claims or actions arising out of, or resulting from any use of such image. High Hopes Therapeutic Riding, Inc. shall not be obligated to use, and may elect not to use, any image.   



If applicant is under 18 years of age, parent/guardian signature is required.

Confidentiality Policy

At High Hopes, we place great importance on protecting the confidential information of our clients, our staff and our volunteers. “Confidential information” includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of High Hopes. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as confidential information.  I shall never disclose confidential information to anyone other than High Hopes staff.  I must seek staff permission before taking any pictures or videos. I have read and understand High Hopes Confidentiality Policy and agree to abide by same.


If applicant is under 18 years of age, parent/guardian signature is required.

Liability Release

I acknowledge the risks and potential for risks of horseback riding and related equine activities including grievous bodily harm. However, I feel that the possible benefits to myself are greater than the risks assumed.  I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against High Hopes Therapeutic Riding Inc., its Board of Trustees, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries and/or losses I may sustain while participating in activities at High Hopes from whatever cause, including but not limited to the negligence of these related parties.

 

The undersigned acknowledges that he/she has read this registration form in its entirety; that he/she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof. 


If applicant is under 18 years of age, parent/guardian signature is required.

Participant Forms Acknowledgement

Step 1: Learn About Volunteering

The required age for volunteers is 14. We encourage anyone who is interested in volunteering to review our frequently asked questions for prospective volunteers.

Prospective Volunteers

Step 2: Complete the Waiver

We will need you to complete a waiver and emergency contact information. We would also love to know what brought you to High Hopes and what your volunteer interests are.

Step 3: Register for an Orientation

New volunteers are required to attend a general orientation session. After general orientation, new volunteers will select the role(s) they would like to perform, and will attend an additional training session specific to that role(s).

Orientation Registration

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