Thank you for your interest in volunteering at Flying Manes. Before you begin the application process please have your PATH training course certification and a scan/picture of your driver’s license or other photo ID ready to upload with this application. Volunteers under the age of 18 years must have the respective sections in this application signed by a parent or guardian to participate in training and volunteering.Name *FirstLastDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age *Parent/ Guardian Name *FirstLast(for volunteers under 18 years of age)Parent/ Guardian Email *(for volunteers under 18 years of age)Parent/ Guardian Phone *(for volunteers under 18 years of age)Height (feet, inches) *Email *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmployer/ SchoolOccupationYOUR EXPERIENCE AND INTERESTSReason for volunteering: *personal fulfillmentschool requirementcourt required community serviceotherPlease tell us about your experience with individuals with special needs:Please tell us about your experience with horses:Lesson Program Volunteers: I am interested in volunteering for the lesson program in the following way(s):Sidewalking with mounted participantsSupporting unmounted participants Leading horses during lessons (advanced horse experience required)Grooming and tacking horses for lessons (advanced horse experience required)Special Events Volunteer Interests:Serve on special events planning committeesProvide assistance the day of an eventBaking/cookingDo you have any special skills or technical/professional experience that you would like to share?PhotographyPR/Marketing/OutreachFundraising ExperienceGrant WritingGraphic DesignWeb Design/Social MediaSign LanguageOtherPlease describe:Are you currently trained in CPR and/or first aid?CPRFirst AidPlease upload your current CPR/First Aid Certificate)CONFIDENTIALITY POLICYAt Flying Manes Therapeutic Riding, Inc., 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 Flying Manes Therapeutic Riding, Inc. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose confidential Information to anyone other than Flying Manes Therapeutic Riding staff. Volunteers must seek staff permission before taking any pictures or videos. I have read and understand Flying Manes Therapeutic Riding, Inc. Confidentiality Policy and agree to abide by same.Signature *Clear SignatureParent/Guardian Signature *Clear SignatureIf volunteer is under 18 years of age, both parent/guardian & volunteer signatures are required.LIABILITY RELEASEI acknowledge the risks and potential for risks of horseback riding, related equine activities, and working with horses, 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 against Flying Manes Therapeutic Riding Inc., its Board of Directors, Instructors, Therapists, Aides, Volunteers, and/or Employees for any and all injuries, losses and/or costs I may sustain while participating as a Flying Manes volunteer from causes including, but not limited to, the negligence of these related parties or any acts of third parties.Signature *Clear SignatureThe undersigned acknowledges that he/she has read this Volunteer Application & Release 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.Parent/Guardian Signature *Clear SignatureIf volunteer is under 18 years of age, both parent/guardian & volunteer signatures are required.PHOTO & PUBLICITY RELEASEI hereby consent to and authorize the following:I do not consent to, nor do I authorize the following:1) Flying Manes Therapeutic Riding, Inc. may use and reproduce any and all photographs and any other audiovisual materials taken of me for promotional printed material, educational activities, exhibitions, or for any other use for the benefit of the program; 2) I release Flying Manes Therapeutic Riding, Inc., its employees, and any outside third parties from all liabilities or claims that I might assert in connection with the above-described activities; and 3) I waive any right to inspect, approve, or receive compensation for any materials or communications, including photographs, videos, DVDs, website images, or written materials, incorporating photos/images of me.Signature *Clear SignatureParent/Guardian Signature *Clear SignatureIf volunteer is under 18 years of age, both parent/guardian & volunteer signatures are required.AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENTIn the event emergency medical aid/treatment is required due to illness or injury while being on the property of the host facility (Riverdale Stables at 6351 Broadway, New York, NY 10471), I authorize Flying Manes Therapeutic Riding, Inc. to: 1. Secure and retain medical treatment and transportation, if needed. 2. Release records upon request to the authorized individual or agency involved in the medical emergency treatment.Emergency ContactName *FirstLastRelationship *Phone *Primary Care Physician's NameFirstLastPrimary Care Physician's PhonePreferred Medical FacilityHealth Insurance CarrierPolicy # / Member IDPlease indicate any allergies *Please indicate any disability, limitations, medications, or medical conditions that may affect your volunteer role, with or without reasonable accommodation, that we should be aware of: *Consent Plan** to be invoked in the event that your Emergency Contact cannot be reached: I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the host facility (Riverdale Stables at 6351 Broadway, New York, NY 10471).[***If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the host facility (Riverdale Stables at 6351 Broadway, New York, NY 10471), please request a Non-Consent Form, which requires notarization.]Signature *Clear SignatureParent/Guardian Signature *Clear SignatureIf volunteer is under 18 years of age, both parent/guardian & volunteer signatures are required.REFERENCE AND BACKGROUND CHECK INFORMATIONReference Name (non-relative) *FirstLastReference Phone *PLEASE ATTACH A COPY OF YOUR DRIVER'S LICENSE OR OTHER PHOTO ID *Have you ever been charged with or convicted of a criminal offense or have conviction pending, including any misdemeanors? *YesNoIf yes, please provide date and explain nature of offense: *I, *(volunteer name)understand that Flying Manes Therapeutic Riding, Inc. may perform background checks on all volunteers, and I authorize Flying Manes Therapeutic Riding, Inc. to receive information from any law enforcement agency, including police departments and sheriff’s departments, of this state or any other state or federal government, to the extent permitted by state and federal law, pertaining to any convictions I may have had for violations of state or federal criminal laws, including but not limited to convictions for 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 Flying Manes Therapeutic Riding, Inc., its directors, officers, employees, or other volunteers to disseminate this information in any way to any other individual, group, agency, organization, or corporation.The information on my volunteer application will be verified, and I give permission to make inquiry of others concerning my suitability to act as a volunteer at Flying Manes.Signature *Clear SignatureParent/Guardian Signature *Clear SignatureIf volunteer is under 18 years of age, both parent/guardian & volunteer signatures are required.PROFESSIONAL ASSOCIATION OF THERAPEUTIC HORSEMANSHIP INTERNATIONAL -- CODE OF ETHICSPATH Intl.’s Code of Ethics sets forth ethical principles for all PATH Intl. members which includes individuals and centers and is binding on all staff. Centers are obligated to insure that all staff, professionals, and volunteers comply with this code. While each of the following codes will apply to all members, the applicability of each code may be determined by the role of the member and the setting. The practice and preservation of the highest standards of ethical principles and integrity are vital for the responsible implementation of obligations, activities and services provided by PATH Intl. members and centers. All members and centers are responsible for maintaining and promoting these ethical practices. The PATH Intl. Code of Ethics is intended to be used as a guide for promoting and maintaining the highest standards of ethical practice, personal behavior and professional integrity. The guidelines expressed in the code are not to be considered allinclusive of situations that could evolve under a specific principle, nor is the failure to specify any particular responsibility or practice a denial of the existence of such responsibilities or practices. The guidelines are specific statements of minimally acceptable conduct or of prohibitions applicable to all members and centers.Principle 1: The volunteer respects the rights, dignity and well-being of all individuals (human and equine) and promotes well-being for all involved.Principle 2: The volunteer accepts responsibility for the exercise of sound judgment and professional competence.Principle 3: The volunteer shall respect the integrity and well-being of program equines and animals whether owned, leased or borrowed.Principle 4: The volunteer shall be truthful and fair in representing him or herself and other members or centers.Principle 5: The volunteer shall seek to expand his/her knowledge base related to the field of equine-assisted activities and therapies.Principle 6: The volunteer shall abide by PATH Intl. standards and guidelines and all state, local and federal laws.Principle 7: The volunteer supports PATH Intl. in its efforts to protect participants, equines, the public and the profession from unethical, incompetent or illegal practice.In recognition of the responsibility inherent in the delivery of services provided by equine-assisted activities and therapies, I subscribe to the above principles to the extent permitted by law.Print Name *Signature *Clear SignatureParent/Guardian Signature *Clear SignatureIf volunteer is under 18 years of age, both parent/guardian & volunteer signatures are required.PATH ONLINE VOLUNTEER TRAINING COURSEPlease upload your certificate of completion: *If you do not have the certificate yet please email it as soon as possible to volunteer@flyingmanes.org. Agreement I certify that the information within this application is complete and accurate. I understand that making false or fraudulent statements within this application will result in denial of admission to the volunteer program. As a volunteer I agree to abide by the rules and regulations of the program. Should any information change prior to and/or during volunteering, I will notify the volunteer coordinator. I understand that volunteer assignments are made based on program needs and volunteer experience and availability. I understand that because of the nature of the services provided, Flying Manes reserves the right to make the final determination as to the appropriateness of volunteers for the program. Do you understand and agree to the terms listed above? *Yes, I understand and agree to the terms listed above.MessageApply