Annual Volunteer Release

Returning Volunteer Annual Release

Personal Information

Date of Renewal

First Name

Last Name

Phone

Address Line 1

Address Line 2

City

State

Postal Code

Days & Times Available

Medical Information

Significant Medical History

Physical Limitations

Health Insurance Co.

Policy #

Physician

Physician Number

Hospital Preference

Emergency Contact Information

Emergency Contact Name

Emergency Contact Number

Emergency Contact Relationship

Emergency Contact #2 Name

Emergency Contact #2 Phone

Emergency Contact #2 Relationship

Medical Consent Plan

Please sign (or have a parent/guardian sign if you are under 18) either the consent or non-consent plan.

I am over 18 years of age and fully competent to sign this Emergency Medical Form, which I have read and understand, or, if under age, Volunteer has obtained the signature of his/her parent/guardian, who, by such signature, represents he/she has read and understands this form. In case of medical emergency or necessity, “Volunteer” authorizes ATS to seek or provide for Volunteer such medical assistance as may be necessary or advisable and further authorizes ATS to seek the assistance of any physician or medical facility to provide any medical/surgical care, including, but not limited to, hospitalization, with such treatment to include anesthesia as necessary or advisable, that the physician or medical facility deems or determines to be necessary or advisable, pending receipt by the physician or medical facility of any other consent to treatment from or on behalf of Volunteer. Volunteer understands that NO LIABILITY can be accepted by any of the organizations concerned, including ATS, in the event such accident may occur. In the event any provision of this form is determined to be unenforceable, all other provisions shall remain in full force and effect. By putting your name in the box below you are consenting to the above statement.

Emergency Medical Treatment

Volunteer Name (Consent for Medical)

Date

Parent/Guardian Signature

Liability Release

*THIS IS A RELEASE OF YOUYR RIGHTS TO SUE*

STATEMENT OF UNDERSTANDING, AUTHORIZATION RELEASE AND INDEMNITY
I, the undersigned (“Volunteer”), am over 18 years of age and fully competent to make this Statement of Understanding, Authorization, Release and Indemnity (“Statement”), which I have read and understand. I understand the information I have provided may be verified and permit the Autumn Trail Stable (ATS) to inquire of others concerning my suitability as a volunteer. In the course of volunteering, I may deal with confidential information and agree to keep said information in the strictest confidence. The relationship between ATS and me is an “at will” arrangement and may be terminated at any time, without cause, by either ATS or me. I understand that, as a volunteer, I will assist in the riding and instruction of mentally or physically challenged riders, and that I will work with and around horses, as well as riders. I understand that I cannot serve as a volunteer until this statement has been signed. In return for the opportunity to serve as a volunteer with ATS, I hereby forever release, acquit and discharge ATS and its officers, directors, trustees, agents, employees, representatives, affiliates, successors and assigns (collectively the “Released and Indemnified Parties”) from any and all claims, demands and causes of action of any and every kind or nature, including those caused in whole or in part by the negligence of any of the Released and Indemnified Parties, which I man now or in the future have against any or all of the released and Indemnified Parties and that arise in whole or in part as a result of my involvement with ATS. I also understand and agree that ATS assumes no liability for accidents or acts of negligence or gross negligence by anyone, including the Released and Indemnified Parties. I further agree to fully indemnify and defend any of the Released and Indemnified Parties against any and all claims, demands or causes of action of any and every kind or nature (including attorney’s fees and other defense costs), including those caused in whole or in part by the negligence of any or all of the Released and Indemnified Parties, which directly or indirectly relate to personal injuries or property damages sustained by me and that arise in whole or in part as a unenforceable, all other provisions shall remain in full force and effect.

OHIO STATEMENT OF INHERENT RISKS
Inherent risk of an “equine activity” means a danger or condition that is an integral part of an equine activity, including, but not limited to, any of the following: A. The propensity of an equine to behave in ways that may result in injury, death, or loss to persons on or around the equine; B. The unpredictability of an equine’s reaction to sounds, sudden movement, unfamiliar objects, persons, or other animals; C. Hazards, including, but not limited to, surface or subsurface conditions; D. Collision with another equine, another animal, a person, or an object; E. The potential of an equine activity participant to act in a negligent manner that may contribute to injury, death, or loss to the person of the participant or to other persons, including but not limited to, failing to maintain control over an equine or failing to act within the ability of the participant.

By entering your name in the box below you are consenting to the above statement.

Volunteer Name (Liability)

Date

Parent/Guardian Signature (if volunteer is under 18)

Confidentiality Agreement/Policy

As an ATS volunteer, I understand that any information regarding a student and the student’s family is to remain confidential. This refers the student’s progress as well as personal information. In addition, I will immediately report to the instructor/program director any sensitive information relayed to me concerning the student(s).
By entering your name in the box below you are consenting to the above statement.

Volunteer Name (Confidentiality)

Date

Parent/Guardian Signature (if volunteer is under 18)

Photo Release

Please check one box and enter your name in the box below.

I consent to and authorize the use and reproduction by ATS of any and all photographs and any audio-visual materials taken of me for promotional material, educational activities, exhibitions and digital displays or for any other use for the benefit of the program. With respect to the foregoing matters, no inducements or promises have been made to secure this signature to this release other than the intention of ATS to use, or cause to be used, such photographs, films, and pictures for the primary purpose of promoting ATS and its workI do NOT consent to the Photo Release.

Volunteer Name (Photo Release)

Date

Parent/Guardian Signature (if volunteer is under 18)

Social Media Policy

Autumn Trails Stable (ATS) embraces social media and relies on our staff and volunteers to increase our online presence and build our brand. It is one of the most powerful platforms we have to share our mission, create positive awareness for our organization, and engage with our community on a daily basis. We highly encourage our staff and volunteers to engage with ATS' social platforms by liking, commenting, and sharing our posts.

**ATS Videos and Photography**

Due to the sensitive and personal nature of our participants and the services we offer, we must exercise every precaution when engaging with social media platforms. ONLY DESIGNATED STAFF, (CEO, COO, Equine Operations Manager, Program Manager) MAY APPROVE TAKING AND POSTING ANY PHOTOGRAPHS OR VIDEO OF AN ATS PARTICIPANT, VOLUNTEER, ATS FACILITY, HORSE OR EMPLOYEE. Once approval is given to take a photo, one of the staff members above must approve the final photo for posting on social media or other uses. Approval will be given on a case by case basis.

Where to find ATS

Facebook autumntrailsstable

Instagram autumntrailsstable

ALWAYS:

Help ATS spread the good word - share and regram ATS posts on your own social platforms.
Follow the ATS confidentiality policy.
Refer to ATS horses in a positive manner and forward inquiries about ATS horses to a staff member.
Think twice before posting. If you have any doubt, please do not post.

NEVER:

Claim to be an official representative of ATS.
Share confidential information about a participant, volunteer, employee or the organization.
Take photographs or video of a ATS participant, volunteer, horse or employee unless specifically requested to by a designated staff member.
Use language that is profane, harassing, racial, political, religious, or that is considered biased or slurred when posting about ATS.
Refer to an ATS horse or the ATS barn environment negatively.

Violation of Social Media Policy

If a social media post is discovered that is in violation of this policy, you will be asked by a staff member to remove the post. Failure to remove a post could result in verbal or written warning or immediate dismissal from the ATS facility and program.

Volunteer Name (Social Media)

Date

Parent/Guardian Signature (if the volunteer is under 18)

COVID-19 ACKNOWLEDGEMENT OF RISK AND ACCEPTANCE OF SERVICES

I am aware of the risks of contracting or spreading Covid-19 while working or volunteering at Autumn Trails Stable, Inc.; attending an event; and/or receiving face-to-face services from Autumn Trails Stable, Inc. during the time of a pandemic outbreak and going forward.

I am aware that face-to-face services and experiences increase my risk of contracting and passing on the Covid-19 or Coronavirus and agree to hold harmless Autumn Trails Stable, Inc. and its residents, members, officers, managers, agents, employees and all other individuals I may come in contact with during this interaction and receiving of services, providing services, attending an event or volunteering within this organization.

I agree to and will follow all guidelines for personal hygiene, personal safety and public safety as recommended by Autumn Trails Stable, Inc.; as well as my individual provider/practitioner. This may include, but is not limited to, waiting in my vehicle and/or home until I am asked to enter the building/farm; maintaining social distance; washing my hands prior to and following each session or activity; use of hand sanitizer upon request; wiping down surfaces with disinfecting wipes and/or wearing a protective medical mask and/or gloves.

I agree to stay home and/or cancel my services should I have personally exhibited or have been in contact with someone who has presented with illness within the previous 24 hours to 2 weeks, including; cough, sneezing, fever, chest congestion or additional signs of potential spread of any virus or bacteria/disease. In addition, I will follow the recommendations of my provider once I have notified them of these risks in regards to my future services or attendance during this pandemic.

Autumn Trails Stable, Inc. will engage in regular cleaning and sanitizing of the facility, horse tack, grooming supplies and office, doors, and frequently touched areas in-between clients and on a daily basis as recommended by the CDC for the safety of clients, employees, volunteers and horses.

I am signing under my own free will and agree to follow these and hold harmless all individuals associated with or through my services acquired from Autumn Trails Stable, Inc.

BY ENTERING MY NAME BELOW, I CONFIRM THAT I HAVE READ AND UNDERSTAND THIS DOCUMENT.

*In the event that the undersigned is under the age of 18, the signature of a parent or guardian is required.

Volunteer Name (Covid)

Date

Parent/Guardian Signature (if the volunteer is under 18)

Volunteer Manual

By entering my name below, I confirm that I have read and understand the Volunteer Manual.

Volunteer Name (Manual)

Date

Parent/Guardian Signature (if the volunteer is under 18)

Stay Connected

These are some of the important ways to stay connected and receive important updates from ATS...

Like the ATS Volunteers Facebook Page (www.facebook.com/ATSvolunteers)?
Like the Autumn Trails Stable Facebook Page (www.facebook.com/autumntrailsstable)?
Check out the Volunteers Page on our website (www.autumntrailsstable.com/our-current-volunteers)?
Receive the Weekly Email Reminders (typically sent on Saturday or Sunday)?
Enter the ATS VOLUNTEER LINE into your phone - (937) 831-0140 (Contact this number by test if you have any questions.)

Contact Information

Returning Volunteer Annual Release

Personal Information

Medical Information

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