Volunteer Registration Form

Preferred method of contact:


Volunteer Interests (check all that apply)

Please Note: Previous horse experience is required to be a lead walker during lessons.

What are your reasons for wanting to volunteer at Victoria Acres?


Availability

What days are you available?


Confidentiality Policy

At Victoria Acres Equine Facility, Inc., we place great importance on protecting the confidential information of our staff, volunteers, and especially our clients. “Confidential information" includes, but is not limited to, personally identifiable information such as surnames, telephone number, addresses, emails, etc., as well as the non - public records of Victoria Acres. 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 Victoria Acres staff. Volunteers must seek staff permission before taking any pictures or videos.


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 Victoria Acres Equine Facility, Inc., its Board of Directors, instructors, therapists, aides, volunteers, and / or employees for any and all injuries and / or losses I may sustain while participating as a Victoria Acres volunteer from whatever cause including, but not limited to, the negligence of these related parties.


Photo and Publicity Release

Please read each of the following items before choosing a selection below.

1) Victoria Acres Equine Facility, Inc. to use my (my child's) photograph or image in its print, online and video publications ;
2) Release Victoria Acres Equine Facility, 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, videotapes, DVD's, website images or written materials incorporating photos / images of me (my child)

I hereby consent to and authorize the aboveI DO NOT consent to, nor do I authorize the above


Authorization for Emergency Medical Treatment for Volunteers

In the event emergency medical aid / treatment is required due to illness or injury while being on the property of Victoria Acres, I authorize Victoria Acres 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.


Consent Plan

(to be invoked in the event that your emergency contact cannot be reached)

I give consent for emergency medical treatment / aide (including X - ray, surgery, hospitalization, medication and any treatment procedure deemed "life saving" by a physician in the event of illness or injury while on the property of Victoria Acres.