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Therapeutic Horseback Riding

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Corporate Volunteering

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Sponsor an Animal

Therapeutic Horseback Riding

Horse-Assisted Learning

Garden-Assisted Learning

Supported Volunteering

Schools & Organizations

Corporate Volunteering

Farm to Stable Affair

Horse Show & Family Fair

Corporate Experiences

Yearlong Sponsorships

Event Sponsorships

Corporate Team Building

Corporate Volunteering

Research & Academics

Publications & Media

Community & Academic Partnerships

Our Human & Animal Team

Sponsor an Animal

Folder: Programs

Therapeutic Horseback Riding

Horse-Assisted Learning

Garden-Assisted Learning

Supported Volunteering

Schools & Organizations

Folder: Volunteer

Corporate Volunteering

Farm to Stable Affair

Horse Show & Family Fair

Folder: Corporate Experiences

Yearlong Sponsorships

Event Sponsorships

Corporate Team Building

Corporate Volunteering

Folder: Research & Academics

Publications & Media

Community & Academic Partnerships

Our Human & Animal Team

Folder: Support

Sponsor an Animal

Apply to

Volunteer

VOLUNTEER APPLICATION

Thank you for your interest in volunteering! Parents must complete the application for those under age 18.

Volunteer Information

First Name

Last Name

Email of Volunteer

Cell Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth

Are you under the age of 18?

YesNo

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone

Parent/Guardian Email

How did you hear about Pony Power?

Did a person or organization refer you to Pony Power? If so, who?

Volunteer Background Information

Are you currently a student and/or employed?

StudentEmployedBoth a student and employedNeither a student nor employed

Name of school and/or employer:

Do you have experience working with horses? Experience includes, but is not limited to owning a horse, taking riding lessons, or working at an equine facility.

YesNo

Please explain your experience:

Where did you ride/own/care for horses?

How long have you been working with horses?

Have you ever been convicted of a crime or do you have a pending conviction?

YesNo

Please describe:

I authorize Pony Power 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 laws, including but not limited to convictions for crime committed upon children or animals. I understand that such access is for the purpose of considering my applications as an employee/volunteer and that I expressly DO NOT authorize Pony Power, its directors, officers, employees, or other volunteers to disseminate this information

I do

Health History

Volunteer Responsibilities Include:

Must be able to walk for up to 90 minutes in a dirt arena and jog for short distances.
May be asked to support riders up to 180 pounds (limited)
Must be able to lift and move approximately 30 pounds, for example water buckets and full wheelbarrows.
Have the ability to follow directions in a fast-paced environment.

Do you have any physical limitations or medical conditions/medications that may interfere with your ability to perform the required volunteer work? If so, please explain.

Do you have any allergies to food or medication?

YesNo

Please list any allergies:

Emergency Contact Information

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Relationship to Volunteer

In the event emergency medical aid/treatment is required due to illness or injury the process of receiving services, or while being on the property of the agency, I authorize Pony Power to: 1.) Secure and retain medical treatment and transportation if needed. 2.) Release client records upon requests to the authorized individual or agency involved in the medical emergency treatment. This authorization includes x-ray, surgery, hospitalization, and any treatment procedure deemed "life saving" by the physician. The provision will only be invoked if the person(s) above is unable to be reached.

I consent

Availability

I am interested in volunteering in:

Lessons as a lead walker or side walkerFarm crewGarden crew

I am available in the mornings on the following days:

SundayMondayTuesdayWednesdayThursdayFridaySaturdayUnsureUnavailable

I am available in the afternoons on the following days:

SundayMondayTuesdayWednesdayThursdayFridaySaturdayUnsureUnavailable

Do you need to complete community service hours?

YesNo

How many hours?

Authorizations

I consent to and authorize the use and reproduction by Pony Power Therapies 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.

I doI do not

Initials

I understand that all information written and verbal about participants at Pony Power, is confidential and will not be shared with anyone without the expressed written consent of the participant and their parent/guardian in the case of a minor.

I do

Initials

As a volunteer at Pony Power Therapies, Inc., I acknowledge the risks and potential for risks of a horseback riding program. However, I feel that the possible benefits to me and clients I work with are greater than the risk 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 Pony Power Therapies, Inc,. its Board of Directors, instructors, therapists, volunteers, and/or employees for any and all injuries and/or losses I may sustain while participating in Pony Power Therapies, Inc. I also understand that I am an at-will volunteer and at any time can be dismissed for any reason at the discretion of Pony Power Therapies, Inc.

I do

Initials

I understand that the information provided above is accurate to the best of my knowledge. I know of no reason why I should not participate in this center's program.

I do

Initials

Date

Pony Power Therapies

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