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. 

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