Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Can you receive text messages at this number? *

Yes

No

Emergency contact phone number *

(###)

###

####

Are you over 18 years old? *

Yes

No

Please check all that apply to you:

I can maneuver over uneven terrain.

I can move around in a small office space easily.

I can lift up to 20 pounds.

I can work in the sun for several hours (with breaks as often as needed).

I can use household tools safely.

I can push a full wheelbarrow a short distance.

I have medical insurance that covers my participation in volunteer activities.

Please check all that apply to you:

I can maneuver over uneven terrain.

I can move around in a small office space easily.

I can lift up to 10 pounds.

I can work in the sun for several hours (with breaks as often as needed).

I can use household tools safely.

I can push a full wheelbarrow a short distance.

I have medical insurance that covers my participation in volunteer activities.

Please check all that apply to you:

I can maneuver over difficult or uneven terrain independently.

I am not afraid of horses.

I can lift up to 40 pounds.

I can work in the heat or cold for several hours (with breaks as often as needed).

I can push a full wheelbarrow short distances and up slight ramps.

I am willing to tend to superficial wounds on a horse.

I have medical insurance that covers my participation in volunteer activities.

Do you currently (check all that apply):

Work or volunteer full-time

Work or volunteer part-time

Run your own business

Go to school full-time

Go to school part-time

Are you (check all that apply):

A stay-at-home parent

Retired

Unemployed

Does your employer support community volunteerism by offering monetary grants to organizations where you volunteer?

Yes

No

I’m not sure but I will look into it!

NA

Monday

AM

PM

Flex

Tuesday

AM

PM

Flex

Wednesday

AM

PM

Flex

Thursday

AM

PM

Flex

Friday

AM

PM

Flex

Saturday

AM

PM

Flex

Name *

First Name

Last Name

Phone number *

(###)

###

####

FINISH AND SUBMIT *

By checking this box, you affirm that the information you've provided in this application is true and accurate to the best of your knowledge.