RGR Volunteer Team Member Application Reigning Grace Ranch RGR Volunteer Team Member Application Reigning Grace Ranch 28614 N. 172nd Street, Rio Verde, AZ 85263 www.azrgr.org • email@example.com • 480-466-2154Step 1 of 911%Name* First Last Email* Name as I would like it to appear in publications:*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone*Cell Phone*Text Messages Ok?*YesNoWould you like reminder notifications for classes, clinics, etc.*EmailTextBothBirthdate*If you are under 18 years old, a parent or guardian must sign all of the releases below. Date Format: MM slash DD slash YYYY Veteran?*YesNoShirt Type*MensLadiesShirt Size*SmallMediumLargeExtra Large AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENTIn the event that I require emergency medical aid/treatment due to illness or injury while participating, volunteering, or on the property of Reigning Grace Ranch, I authorize REIGNING GRACE RANCH to:Secure and retain medical treatment and transportation as needed at my own responsibility.Release participant records upon request to the authorized individual or agency involved in the medical emergency treatment.Call contacts on my Emergency Contacts list to alert them of my injury or illness and advise them of my location.Physician's Name* First Last Medical Care System*Physician's Phone*Health Insurance Co.*Health Insurance ID*Preferred Medical Facility*Any Known Allergies?*YesNoPlease list all known allergies below:*Are you taking any medications?*YesNoPlease list all medications below:* CONSENT /NON-CONSENTConsent Plan: This authorization includes x-ray, surgery, hospitalization, medication and/or any procedure deemed “lifesaving” by the physician. This provision will only be invoked if the person listed below is unable to be reached. CONSENT SIGNATURE*Emergency Contact Name First Last Emergency Contact PhoneEmergency Contact Address Street Address City State / Province / Region ZIP / Postal Code In the event that I cannot speak for myself, and my designated emergency contact person cannot be reached, please contact the following individuals in order with regard to my condition, to make decisions on my behalf.1. Name First Last PhoneRelationship2. Name First Last PhoneRelationship3. Name First Last PhoneRelationshipNon-Consent Plan: I do not give my permission for emergency medical treatment/aid in the case of illness or injury during the process of receiving services or while being on the property of the Agency, in the event emergency treatment/aid is required, I wish the following procedures to take place:Initial by making your choice below*I ConsentI Do Not ConsentSIGNATURE OF VOLUNTEER OR PARENT/GUARDIAN*Today's Date* Date Format: MM slash DD slash YYYY VOLUNTEER PROFILEPlace of Employment*Type of work?*Does your place of employment have a matching program?Many companies, organizations and credit unions, offer a matching fund program to match employees’ financial donations or volunteer hours to designated charities. RGR is such a charity.YesNoAre you volunteering to full-fill school/internship/community service hours?*YesNoSchool NameClass NameWhat days are you available?* Select All Monday Tuesday Wednesday Thursday Friday Saturday SundayWhat time of the day are you available?* Morning: 7AM-11AM Mid-Day: 11AM-4PM Evening: 3PM-8PMHow did you hear about Reigning Grace Ranch?*It is helpful for us to know what the most effective means of drawing volunteers.Please describe your horse experience (if any)?We will offer training, but do not want to put anyone in harms way.Have you worked with people that have disabilities before?*YesNoIf Yes, Please ExplainHave you had an immunization against Tetanus in the past 10 years?*YesNoIf Yes, Please ExplainAre you aware of any physical, mental or emotional condition that may limit your volunteer tasks?*YesNoIf Yes, Please ExplainI have a physical condition that would interfere in my safety or ability to ride, drive or train a horse*YesNoI have a mental condition that would interfere in my safety or ability to ride, drive or train a horse*YesNoDo you speak a language other than English?*YesNoDo you know American Sign Language?*YesNoWhat languages do you speak?Are you currently certified in CPR/First Aid?*YesNoWould you be interested in taking any CPR/First Aid Trainings?*YesNoTime CommitmentReigning Grace Ranch is a volunteer dependent non-profit organization. Many of our participants have been on a waiting list to participate in the program. Their participation depends upon their volunteer’s attendance.*I Initial/AgreeMentors and Horse Leaders will be asked to commit for specific days and times, your mentee’s participation relies on your attendance. Sessions run for 8 weeks, sometimes due to weather the schedule re-arranged, we ask Mentors to do their best to work with these inconveniences.*I Initial/AgreeRGR wants you to know that a child’s participation in the program depends upon you.*I Initial/AgreeIf you were not able to commit to an entire 8-week session, would you be willing to fill in as an ‘on call’ mentor when you were available?YesNoIf so, how far ahead would you need to know that you were needed?How long does it take you to arrive to RGR if you were called for an emergency substitution?*Physical CommitmentCan you walk briskly for 30 minutes beside a horse?*YesNoAre you comfortable jogging beside a horse for a short distance?*YesNoGiven the chance to change sides, can you hold one of your arms above your shoulder and support modest weight?*YesNoDo you have any physical limitations or medical conditions which we should know about?*YesNoHow can we accommodate? RGR VOLUNTEER OPPORTUNITIESVolunteering is a tremendously self-rewarding adventure. At Reigning Grace Ranch, you can choose from a great variety of tasks, commitments and long-term responsibilities that support RGR programs. Whatever your interests, talents, and abilities; they will be put to excellent use at Reigning Grace Ranch!Following are some broad descriptions of our areas of need, answer Yes in the areas that interest you.ADMINISTRATIVE & MARKETINGData entry, drafting correspondence, meeting notes, phoning, research, accounting, create newsletters, maintain our website, create storyboards, take pictures and reach out to others to share your passion.YesLANDSCAPING & FACILITY MAINTENANCEAre you a handyman or green thumb type? We can always use help to maintain and improve the premises. Weed, plant, water or design! Come out to make Reigning Grace Ranch more aesthetically pleasing with your ideas and expertise.YesFUNDRAISING OR GRANT WRITINGThese Super Stars reach out to local businesses to donate goods and products for raffles and auctions throughout the year. They also help keep our riders in the saddle.YesVOLUNTEER SUPPORTAttend volunteer fairs at local schools and companies to promote the various volunteer opportunities available to our community. Help develop and assist with orientations and training throughout.YesSPECIAL EVENTSAttend local equine events to promote Reigning Grace Ranch, spend time planning a fundraiser, dinner, and auction or any other amazing events! Also looking for musicians.YesPADDOCK MANAGEMENTLooking to roll up your sleeves and get a little dirty? Well look no further! Help with paddock cleaning, feeding, turn out, etc. No horse experience required, however, you must be able to work independently alongside our other ranch buddies.YesRANCH HAND / EQUINE HEALTHIf you are interested in being a part of the horse care team, we have opportunities in supplemental food, feeding horses, cleaning water troughs, grooming, and providing general first aid. No experience needed, just a love for horses and a willingness to complete the training.YesMENTOR / HORSE LEADERIf you are interested in spending time with a child and teaching them how to develop a healthy bond between human and horse, this job is for you. Must enjoy children, talking and being uplifting and encouraging.YesDo you have any other particular skills that you would like to share with RGR? Please explain: RISK MANAGEMENT STATEMENTSPlease initial your agreement of the following statements:I understand that I cannot smoke while on the property of Reigning Grace Ranch.*I Initial/AgreeI understand that I may not use ranch vehicles without proper training.*I Initial/AgreeI understand that injury of horses or humans, and liability may occur if gates are left open.*I Initial/AgreeI understand Reigning Grace Ranch has a designated business hour during which staff are present on property.*I Initial/AgreeI understand that I must wear an ASTM approved riding helmet to ride any horse.*I Initial/AgreeI understand that I must not ride a horse that is listed above my ability level.*I Initial/AgreeI understand that horses are not to be fed anything by hand. Hand feeding encourages biting and nipping.*I Initial/AgreeI understand that horses are unpredictable. They may kick bite and step on me.*I Initial/AgreeSIGNATURE OF VOLUNTEER OR PARENT/GUARDIAN* PHOTO / VIDEO RELEASEI understand that I consent to and authorize the use and reproduction of any and all photographs and any other audiovisual materials taken of me, my son/daughter or ward, for promotional printed material, educational activities, social media and exhibitions or for any use for the benefit of Reigning Grace Ranch.Do you Consent?*I ConsentI Do Not ConsentSIGNATURE OF VOLUNTEER OR PARENT/GUARDIAN* CONFIDENTIALITY STATEMENTSVolunteers, riders and their families have a right to privacy that gives them control over the dissemination of their social, medical and/or other sensitive information. Reigning Grace Ranch shall preserve that right of confidentiality for all individuals in its program.I, by signing below, acknowledge this policy and will abide by it.SIGNATURE OF VOLUNTEER OR PARENT/GUARDIAN* Reigning Grace Ranch28614 N 172nd Street, Rio Verde, AZ 85263 (“premises”, “property”)VISITATION, PARTICIPATION AGREEMENT (the “Agreement”):READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. IT CONTAINS LEGAL CONSEQUENCES THAT WILL AFFECT YOUR LEGAL RIGHTSAND ELIMINATE YOUR ABILITY TO BRING FUTURE LEGAL ACTIONS.RELEASED PARTIES INCLUDE: Reigning Grace Ranch, its agents, owners, officers, volunteers, participants, employees, landlords and propertyowners and all other persons or entities acting in any capacity on their behalf (collectively referred to as “Stable”). RELEASING PARTIES INCLUDE:The undersigned participant and minor(s) listed in the Agreement, participant's spouse, children, parents, guardians, heirs, next of kin, and any legal orpersonal representatives, executors, administrators, successors and assigns, or anyone else who might claim or sue on participant's behalf.AGREEMENT:IN CONSIDERATION OF STABLE’S SERVICES: I hereby agree to release and discharge Stable on behalf of myself, my heirs, assigns, personal representatives, my estate and any other person listed in this Agreement (cumulatively “participant”, “I”, “myself), and as follows:RELEASE OF LIABILITY, ASSUMPTION OF RISK, INSTRUCTION, JURISDICTION, VENUE:(1) I understand that by my presence on Stable premises, I may engage in activities or utilize the premises in a way that may involve inherent risks that are beyond the control of Stable. Stable has taken precautions to provide a safe setting, but I understand that the possibility of injury, death, or loss to persons is present. Activities may include, but are not limited to, physical activity, walking/running, group games, sports, aquatic activities, general recreation, general use of grounds including its improvements, working on projects in a woodshop, baking, craft making, handling and petting dogs, chickens, goats, horses, pigs and cows. By signing below, I hereby give consent for the below mentioned participants to use the grounds and activities.(2) I further agree that horseback riding and all equine activities are inherently dangerous activities and that these activities will expose me to significant risks, both known and unknown, which could result in physical or emotional injury, or damage to myself, to property, or to third parties.(3) I expressly agree and promise to accept and assume all the risks existing in Stable activities, both known and unknown, whether caused or alleged to be caused by the negligent acts or omissions of Stable. My participation in all Stable activities is purely voluntary and I elect to participate in spite of the risks.(4) I agree to acknowledge all of Stable’s rules and regulations pertaining to any and all activities (equine or otherwise) occurring on or off of Stable’s property. I agree to and I am responsible for wearing protective gear appropriate for said activities to ensure my safety while engaging in same.(5) I understand that protective gear includes, but is not limited to, protective headgear. I agree that Stable has fully warned and advised me that protective equine headgear that meets or exceeds the quality standards of the SEI certified ASTM standard F1163 equestrian helmet should be worn while riding, driving, training, or being near horses. I understand that wearing such protective headgear at these times may reduce the severity of some of the wearer’s head injuries and possibly prevent the wearer’s death. I am not relying on Stable to provide a certified equestrian helmet for me, to check any headgear or equestrian helmet that I may wear, to check any headgear strap or equestrian helmet strap that I may wear, or to monitor my compliance with this suggestion at any time now or in the future.(6) I understand the risks, conditions, and dangers inherent in all Stable activities, including equine activities. I agree to assume any and all risks involved in my use of or presence upon Stable’s property and facilities while engaging in any activity without limitation. These risks include, but are not limited to, death, bodily injury, property damage, falls, kicks, bites, unavailability of emergency medical care, the ordinary negligence of another person, and the deliberate acts of another person. I understand that 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 direction or speed, shifting its weight, bucking, rearing, kicking, biting, or running from danger. The same is true for other animals upon the property. I acknowledge that these are just some of the risks and I agree to assume others not mentioned above.(7) I agree that Stable is not responsible for total or partial acts, occurrences, or elements of nature or unfamiliar sights, sounds or sudden movements that may scare an animal, including a horse, cause it to fall, or cause it to react in some other unsafe way. Some examples include: thunder, lightning, rain, wind; wild and domestic animals, insects, reptiles, which may walk, run or fly near, or bite or sting a horse or person; and irregular footing on out-of-door groomed or wild land which is subject to constant change in condition according to weather, temperature, and natural and man-made changes in landscape. I also acknowledge that these are just some of the risks and I agree to assume others not mentioned above. I have inspected Stable’s facilities and am satisfied that all premise conditions are reasonably safe for my intended purpose, usage and presence upon Stable’s premises.(8) I agree to stay out of all barns, paddocks, corrals, tack-rooms, and all other non-office related buildings while waiting for horse related or other activities or while waiting for a participant of such activities.(9) I acknowledge that saddle girths (the fastener straps around a horse’s belly) may loosen during riding. I must alert the instructor or attendant of any girth looseness, so action can be taken to avoid slippage of the saddle and the potential for me to fall from the horse.(10) I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Stable from any and all claims, demands, or causes of action, which are in any way connected with my participation in these activities or my use of Stable’s equipment or facilities, including any such claims which allege negligent acts or omissions by Stable.(11) I agree not to sue or initiate any legal action (whether in court or in arbitration) against Stable or any present or future owners, officers, members, managers, agents, employees and representatives of Stable, in connection with any claim which could have been or could be raised against any of them in any way connected with, arising out of, or relating to, personal injury or damage to the maximum extent permitted by law.(12) I certify that I have adequate insurance to cover any injury I may suffer while participating, or otherwise agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions, which could interfere with my safety in this activity, or am otherwise willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition.(13) I understand that in this Agreement the terms “horse” and “equine” mean all equine species, including, but not limited to, horses, ponies, mules, and donkeys.(14) I understand that this Agreement is in addition to, and not in lieu of, Arizona State Statutes 12-553 (Actions Arising Out of Equine Activities).MISCELLANEOUS: (15) I agree these releases are binding upon me, the minor(s) below for whom I am contracting, my heirs, executors, administrators, legal representatives, and successors.(16) Should Stable or anyone acting on its behalf be required to incur attorney’s fees and costs to enforce this Agreement, I agree to indemnify and hold them harmless for all such fees and costs.(17) I agree that the validity and enforceability of this Agreement will be governed by the substantive law of Arizona without regard to its conflict of law rules.(18) If a provision of this Agreement is determined to be unenforceable in any respect, the enforceability of the provision in any other respect and of the remaining provisions of this Agreement will not be impaired.(19) I agree that any action, suit, or proceeding arising out of the subject matter of this Agreement will be litigated in courts located in Maricopa County, Arizona. I consent and submit to the jurisdiction of any local, state, or federal court located in Maricopa County, Arizona.(20) I agree that the releases herein are continuing in nature and that a new release shall not be required for each time I am on the premises.SIGNATURE OF VOLUNTEER OR PARENT/GUARDIAN*The parties agree that this document may be electronically signed. The parties agree that the electronic signatures appearing on these documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.After clicking submit you will be directed to our Volunteer Donation Form. We ask all first-time volunteers to make a $25.00 donation to cover the security clearance, administrative and defrays the costs of volunteer training. Volunteer training is scheduled when security clearance is received.CommentsThis field is for validation purposes and should be left unchanged.