Volunteer Form

Thank you for your interest in the volunteer program at Ironstone Farm! Volunteers are needed Monday - Saturday, year-round, and are asked to commit to between 1-3 hours each week. Our volunteers assist with therapeutic horseback riding by leading horses during lessons and sidewalking next to our clients, providing physical/emotional support and encouragement.

Once we receive your completed application, we will invite you to a Volunteer Training Workshop. After the training workshop, we will work with you to schedule a volunteer time based on our current needs and your availability.

Your Information

First Name(Required)

Last Name(Required)

DOB(Required)

Are you under the age of 18?(Required)

Yes

Address(Required)

Street Address City State ZIP Code

Home Phone

Mobile Phone(Required)

Work Phone

Email(Required)

What is the best way to contact you?(Required)

Occupation

Place of Business/School

How did you hear about our volunteer program?

(e.g., word-of-mouth, ﬂyer, friend, newspaper, Internet, VolunteerMatch, etc.)

Volunteers walk alongside riders (physically supporting or spotting the rider) and/or lead horses during therapeutic sessions (controlling the horse at all times). Do you have any health issues, diagnoses, or physical limitations that would make either responsibility difficult for you?(Required)

Yes

If yes, please explain:(Required)

Are you able to walk for 1-3 hours and jog alongside a horse for very short distances?(Required)

Yes

Can you hold your arm above shoulder height and support a moderate amount of weight (when given a chance to switch sides)?(Required)

Yes

Have you ever been convicted of a criminal oﬀense?(Required)

Yes

If yes, when and where? Please briefly explain:(Required)

Experience

Please tell us about your experience with horses:

Please tell us about your experience with leading/sidewalking:

Please tell us about your experience with people with disabilities:

Have you previously volunteered at Ironstone Farm?(Required)

Yes

When did you previously volunteer?(Required)

Do you have any special skills/talents you would like to share with the Ironstone Farm programs?(Required)

(e.g., sign language, carpentry, photography, baking, grant writing, foreign language, or special events)

Availability

Please indicate the days and times you are available to volunteer. Please be sure to take your work, sports, and/or school schedule into consideration. The minimum volunteer time is 1 hour. Volunteer sessions are typically 1.5-3 hours in length. Most volunteers are expected to commit to a weekly schedule, but if your schedule changes week to week or month to month, please note that below.

Monday

Morning (9:00AM-12:00PM)

Mid-Day (11:00AM-2:00PM)

Afternoon (2:00PM-4:30PM)

Evening (4:30PM-7:30PM)

Other

Tuesday

Morning (9:00AM-12:00PM)

Mid-Day (11:00AM-2:00PM)

Afternoon (2:00PM-4:30PM)

Evening (4:30PM-7:30PM)

Other

Wednesday

Morning (9:00AM-12:00PM)

Mid-Day (11:00AM-2:00PM)

Afternoon (2:00PM-4:30PM)

Evening (4:30PM-7:30PM)

Other

Thursday

Morning (9:00AM-12:00PM)

Mid-Day (11:00AM-2:00PM)

Afternoon (2:00PM-4:30PM)

Evening (4:30PM-7:30PM)

Other

Friday

Morning (9:00AM-12:00PM)

Mid-Day (11:00AM-2:00PM)

Afternoon (2:00PM-4:30PM)

Evening (4:30PM-7:30PM)

Other

Saturday

Morning (9:00AM-12:00PM)

Mid-Day (11:00AM-2:00PM)

Are there any other notes about your schedule you would like us to know about? Or other timesnot listed above that work best for your schedule?

Are you volunteering for a school, organization, or company requirement?(Required)

Yes

If yes, please indicate the number of hours you must complete and the time frame that you need to complete the hours.(Required)

Emergency Contact Information

Emergency Contact Name #1:(Required)

Relation(Required)

Home Phone

Mobile Phone(Required)

Work Phone

Emergency Contact Name #2:

Relation

Home Phone

Mobile Phone

Work Phone

Name of parent(s)/guardian(s):(Required)

Parent/guardian address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone

Mobile Phone(Required)

Work Phone

Consent

PLEASE READ THE FOLLOWING THREE PARAGRAPHS CAREFULLY

Inherent Risk / Assumption of Risks. I/We acknowledge that: Risks, conditions and dangers are inherent in (meaning an integral part of) horse/equine/animal activities, regardless of all feasible safety measures which can be taken, and I agree to assume them. The inherent risks include, but are not limited to any of the following: the propensity of an animal to behave in ways that may result in injury, harm, death or loss to persons on or around the animal; the unpredictability of an equine’s reaction to sounds, sudden movement, unfamiliar objects, persons or other animals; hazards, including but not limited to, surface or subsurface conditions, a collision, encounter and/or confrontation with another equine, another animal, a person or an object; the potential of an equine activity participant to act in a negligent manner that may contribute to injury, harm, death, or loss to the participant or to other persons, including but not limited to, failing to maintain control over an equine and or failing to act within the ability of the participant. If a horse is frightened or provoked it may divert from its training and act according to its natural survival instincts which may include, but are not limited to, stopping short; spinning around; changing directions and or speed at will; shifting its weight; bucking; rearing; kicking; biting; and or running from danger. I/We also acknowledge that these are just some of the risks and I/We agree to assume others not mentioned above. I/We am (are) not relying on Challenge Unlimited, Inc., Ironstone Therapy, Inc. and/or Ironstone Farm to list all possible risks for me.

Liability Release. I/We agree that: in consideration of allowing my participation in the activities of Challenge Unlimited, Ironstone Therapy and/or Ironstone Farm, I, the student, client or volunteer, for myself and on behalf of my child and/or legal ward, heirs, administrators, personal representatives or assigns, do agree to release, hold harmless, and discharge Challenge Unlimited, Inc., Ironstone Therapy, Inc. and Ironstone Farm, its employees, agents, independent contractors, officers, directors, representatives, assigns, members, and insurers, and others acting on their behalf, of and from all claims, demands, causes of action and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to ordinary negligence or legal liability; and I do agree to release any claims, demands, legal actions and causes of action, against Challenge Unlimited, Inc., Ironstone Therapy, Inc. or Ironstone Farm, and its employees, agents, independent contractors, officers, directors, representatives, assigns, members, and insurers, for any damages due to bodily injury and/or death and/or property damage, sustained by me and or my minor child or legal ward in relation to the premises and operations herein, including, but not limited to, riding, driving, training, handling or otherwise being near or around horses owned, leased or boarded by Challenge Unlimited, Inc., Ironstone Therapy, Inc., or Ironstone Farm.

WARNING

Under Massachusetts law, an equine professional is not liable for injury to, or death of, a participant in equine activities resulting from the inherent risks of equine activities, pursuant to Section 2D of Chapter 128 of the Massachusetts General Laws.

Photo Release(Required)

I understand and agree to the below.

No, I do not consent, and would like to opt out.

I hereby consent to and authorize the use and reproduction by Challenge Unlimited, Inc., Ironstone Therapy, Inc., and/or Ironstone Farm of any and all photographs and any other audiovisual materials taken of me/my child/my ward for promotional material, educational activities, and exhibitions or for any other use for the benefit of the program.

I/We represent that I/We have read this entire agreement and in particular the sections labeled Inherent Risk/Assumption of Risks, Liability Release and Warning.

Signature(Required)

Print Name(Required)

Today's Date(Required)

Parent/Guardian Signature(Required)

I/We represent that I/We have read this entire agreement and in particular the sections labeled Inherent Risk/Assumption of Risks, Liability Release and Warning.

Print Name(Required)

Today's Date(Required)

Thank you for taking the time to complete this application. We strive to bring you in for training as quickly as possible! Do not hesitate to contact the Volunteer Team with any questions or unique circumstances regarding your schedule. We look forward to meeting you in a workshop!

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