Free Rein Volunteer Application

First Name

Last Name

Date of Birth

volunteers must be at least 14 years old

Have you lived in Washington state for the past 3+ years?

YesNoDon't KnowFree Rein requires background checks for all volunteers. This question helps us determine which service to use.

Mailing Street

City

State

Zip Code

Primary Phone

Mobile phone is preferred. Include area code and dashes (ex: 555-555-5555)

Secondary Phone

Include area code and dashes (ex: 555-555-5555)

Email

Referral Source (How did you hear about us?)

PROFESSIONAL EXPERTISE

Employer:

Occupation:

Current School (if a student):

Do you need to complete volunteer hours for school?

Number of Hours Needed

Are you active duty military or a military veteran?

if no, leave blank

What are your hobbies or special interests?

SKILLS/EXPERIENCE

Do you have experience with any of the following? Select all that apply:

Computers or TechnologyPhotography or VideographyFundraising or Event PlanningConstruction or Grounds MaintenanceDigital Marketing or Public Relations

AREAS OF INTEREST

AVAILABILITY

Session Availability (select all that apply):

SPRING (mid Feb - end of May)SUMMER (Jun - Aug)FALL (Sept - mid Dec)WINTER (mid Dec - Jan)

Please list days/times you are generally available:

Please list days/times you are generally UNAVAILABLE. Include any expected vacations or school breaks:

QUESTIONNAIRE

Your answers to the following questions will help us to place you in an appropriate class, recognize a potential match for additional volunteer activities, and identify possible supplementary training opportunities.

Inspiration:
Please describe why you would like to volunteer at Free Rein Therapeutic Riding, including what you hope to get out of your experience as a volunteer.

Horsiness (Horsiness is not a requirement for volunteering!)

Please specify any horse experience you may have:

include how many years, if you've had riding lessons, what style of riding you have done, etc.

Have you ever owned or leased a horse?

If you have any fears in dealing with horses, please explain:

Do you have experience dealing with persons with disabilities?

If yes, please explain:

If you have previous experience with Therapeutic Riding, please explain:

Additional Comments/Questions:

Health Information

Please answer yes or no to the following. Can you...

	Yes	No
Walk for an hour on uneven surfaces
Jog for several minutes – trotting horses during class
Hold your arm raised and out to the side for up to an hour
Able to lift up to 20 pounds above your head
Comfortable physically supporting riders during mounting, riding or dismounting

Please list any physical limitations which may affect your work (this may include recent injuries, mental illness, severe anxiety, heat sensitivity, etc.):

Emergency Medical Treatment

Emergency Contact Name

Emergency Contact Phone

Include area code and dashes (ex: 555-555-5555)

Emergency Contact Alternate Phone

Include area code and dashes (ex: 555-555-5555)

Known allergies:

Please describe any major medical conditions (this may include diabetes, heart or blood pressure conditions, epilepsy, etc.) and any current medications and dosage:

Demographic Information

Having the following information on file greatly improves our ability to apply for grants and other funding resources, and helps us to identify additional opportunities for us to better serve our community. Any information you provide will be kept confidential and anonymous.

Gender

With which pronouns do you identify?

Race / Ethnicity

What is your current employment status?

What is your marital status?

What is your annual household income?

What is the highest degree or level of education you have completed?

What is is your primary language?