Volunteer Information Form
To download the Volunteer Information Form simply click or tap here or use the button below. You will also need to fill out the Volunteer Package.
Pacific Riding for Developing Abilities
Date___________
Volunteer Information Sheet
Surname_______________________________ First Name_________________________________ Address________________________________ City/ Prov. ________________________________ Postal Code___________________ Birthday (mm/dd/year)________________________ Home Ph #(____)______________________ Cell Ph #(____)__________________________ Email_________________________________ Occupation_________________________________ In case of emergency please contact:
Name______________________________________ Contact Phone #(____)___________________ Parent/ Guardian/ Caregiver (if under 19 years of age):
Name______________________________________ Relation_______________________________ Address____________________________________ Phone Number (____)____________________ Availability – Please fill in the times you are available (start to finish)
Monday_______________________ Tuesday_________________________
Wednesday____________________ Thursday________________________
Friday_________________________ Saturday_________________________
Are you sometimes available on a short notice basis? Yes No
Which of the following areas are you interested in volunteering in?
Leading a horse Side walking with rider Barn Work
Horse Shows Braiding/ Grooming Ground Maintenance
Office Work Fundraising Committee Special Events
Carpentry Summer Camps
Volunteer Experience
Experience with people with disabilities:
None Some, please state_____________________________________________________
Experience with horses:
None Some, please state _____________________________________________________
Thank you for your interest in volunteering at PRDA. We hope you will enjoy the time you spend with us.
Health History (back or joint problems, recent surgeries, cardio, visual or auditory problems) ________________________________________________________________________________ _______________________________________________________________________________
Date of last tetanus shot___________________ (It is recommended that you consult your physician if you are not up to date)
Allergies_________________________________________________________________________________ Medications ______________________________________________________________________________ Emergency Medical Treatment – please complete one of the following
Volunteer’s Authorization for Emergency Medical Treatment
In case of emergency, I give permission to Pacific Riding for Developing Abilities to secure medical treatment including X-Ray, surgery, hospitalization and medication.
Volunteer/ Parent/ Guardian Signature ___________________________________Date__________________ Physician________________________ Ph #(____)______________Care Card#_______________________ OR
Volunteer’s Non-Consent for Emergency Medical Treatment
I do not give my consent to Pacific Riding for the Disabled Association to secure medical treatment in case of injury or illness. I wish the following procedures to take place.
________________________________________________________________________________________ ________________________________________________________________________________________ Volunteer/ Parent/ Guardian Signature ___________________________________Date__________________
Criminal record check? Yes, given Date Received_____________
Photo Release
I do do not consent to and authorize the use and reproduction by Pacific Riding for Devloping Abilities of any and all photographs and any other audio-visual materials taken of me for promotional material, educational activities, exhibitions or for any other use for the benefit of the program.
Date__________________ Volunteer/Parent/Guardian Signature_____________________________
Thank you for your interest in volunteering at PRDA. We hope you will enjoy the time you spend with us.