Volunteer Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone *

(###)

###

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Secondary Phone

(###)

###

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Birth Date *

MM

DD

YYYY

Name of Guardian/Caregiver

First Name

Last Name

Guardian/Caregiver Phone

(###)

###

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Guardian/Caregiver Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Availability *

Please check all that apply.

Monday Morning

Monday Afternoon

Monday Evening

Tuesday Morning

Tuesday Afternoon

Tuesday Evening

Wednesday Morning

Wednesday Afternoon

Wednesday Evening

Thursday Morning

Thursday Afternoon

Thursday Evening

Friday Morning

Friday Afternoon

Friday Evening

Saturday Morning

Saturday Afternoon

Saturday Evening

Are you sometimes available on short notice? *

Yes

No

Which of the following areas are you interested in volunteering in? *

Please check all that apply.

Leading a Horse

Side Walking with Riders

Grooming and Tacking

Barn Work

Special Events and Fundraisers

Office Work

Do you have experience working with people with diverse abilities? *

If yes, please state in text box below

Yes

No

Do you have experience working with horses? *

If yes, please state in the text box below.

Yes

No

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Health Challanges *

Please be aware that PRDA is a high risk, intense work environment and it is important for us to assign tasks according to areas of strength. Do you have any physical, emotional or mental health challenges we should be aware of?

Yes

No

Date *

MM

DD

YYYY

Name *

First Name

Last Name

Phone

(###)

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