Sunshine Children’s Home Volunteer Application … Acres Children’s Home Volunteer Application...

SunshineAcresChildren’sHomeVolunteerApplicationInstructions

Two applications are available. If you are interested in the Two Hearts Horsemanship Program, please

print the application designated for that program. Both applications require the same basic instructions

for completion as follows:

These are PRINT ONLY applications in pdf, so each page must be printed and completed by the

applicant. The volunteer packet contains the following information:

Memo (Cover letter) page, Application page, Confidentiality Policy page, Skills/Interest/Education page,

Criminal History Self Disclosure Affidavit (AZ State form – 5 pages), References (3 pages).

The Two Hearts Horsemanship Program volunteer material also contains additional pages as follows:

Application page, Areas of Interest (2 pages), Questionnaire (3 pages), Liability Agreement (3 pages).

OF NOTE: All questions on the AZ Criminal History Self Disclosure Affidavit must be answered. Your

personal information and two questions are on the first page, followed by four additional pages that

require answers. Your signature must be notarized on the first page, so DO NOT SIGN AFFIDAVIT UNTIL

a notary is present to verify your signature. Most credit unions, banks and RV Resorts have notaries

available.

Three references are required. Be sure that three reference pages print and add your name, phone

number and date on the first line so that we will know who is being referenced.

For any questions not answered here, please contact the Volunteer Office at Sunshine Acres Children’s

Home by calling (480) 832‐2540.

Thank you for your interest in volunteering at Sunshine Acres. We are happy to welcome new

volunteers who believe in our Mission and want to help us make a positive difference in a child’s life.

Two Hearts Horsemanship Program Potential Volunteer:

We are so excited that you are interested in participating in our ministry! The idea behind the name

“Two Hearts” is that the loving heart of a horse can help heal the broken heart of a child. Your

specific contribution to this program cannot be overstated. As a volunteer, you add a critical

dimension to this program and we hope that you will be able to combine your love of horses and

children with our mission here.

The Two Hearts Horsemanship Program is hosted at and for the benefit of the children at Sunshine

Acres Children’s Home. Volunteers at Sunshine Acres must complete an application, the Arizona

State Form (Criminal History Self Disclosure Affidavit), references, and obtain a fingerprint clearance

card (if applicable). All materials included in the volunteer application packet must be completed and

returned along with the best time to contact you regarding the opportunities we have for volunteers.

Volunteer Application Process:

Tour – For schedules, call 480-832-2540

Complete application packet

References (3) – Have three friends complete and return your references

Interview with Volunteer Coordinator and Horse Program Director

Fingerprint Clearance Card (if applicable)

Note: The fingerprint application fee of $65 is subject to change by the State of Arizona.

Thank you for your interest in becoming a part of our ministry team! Sincerely,

Cindy Jones

Cindy Jones Director Two Hearts Horsemanship Program

3405 NORTH HIGLEY ROAD, MESA, ARIZONA 85215 (480) 832-2540 FAX (480) 832-2041

TWO HEARTS HORSEMANSHIP PROGRAM

VOLUNTEER APPLICATION

Please complete the following application to be added to our list of potential volunteers. We will be contacting you within the timeframe you have provided below, to match your interests/skills with a need in our program. Contact Information Date of application: _____/_____/_____

Name: _______________________________________________________________

Email: _______________________________________________________________

Address: _____________________________________________________________

City: _____________________________ State: _____________ Zip: _____________

Best number to reach you: ______-______-_______

Date of Birth: _____/_____/_____ Please read over the attached “Areas of Interest” list thoroughly for detailed explanations of each volunteer capacity and carefully consider what your availability as a volunteer will be like. Then check all that apply below. ___ Volunteer Session Instructor ___ Grooming/Clipping

___ Volunteer Ranch Hand ___ Audio/Visual Specialist

___ Fundraiser ___ Office Assistance

___ Photographer/Memory Maker ___ Prayer Team

___ Field Trip Planner ___ Green Thumb

___ Handyman ___ Chaperone

___ Musician ___ Chuck Wagon Gang

___ Seamstress Schedule Please complete the following section to the best of your knowledge. We understand that your schedule may change. Please simply indicate when you would like to make yourself available. Check all that apply. Please check the days of the week you would like to volunteer. Indicate the approximate time you will arrive and depart on the days you have listed. ___ Monday: Start _______ am/pm Finish: ______ am/pm

___ Tuesday: Start _______ am/pm Finish: ______ am/pm

___ Wednesday: Start ______ am/pm Finish: ______ am/pm

___ Thursday: Start ______ am/pm Finish: ______ am/pm

___ Friday: Start ______ am/pm Finish: ______ am/pm

___ Saturday: Start ______ am/pm Finish: ______ am/pm Please also indicate the following:

- My offer to volunteer expires on ______/______/______ OR ______ No expiration

Two Hearts Horsemanship Program – Areas of interest:

Volunteer Session Instructor – This person functions as a part of a ministry team, assisting in

providing horsemanship training to the resident children here at Sunshine Acres who range in age from 6 to 18.

Specific duties include some general barn maintenance, assisting students in fetching, grooming, tacking and

mounting horses; leading, side-walking, and supervising an independent rider. Will provide emotional support

and encouragement. Will be asked to play creative games that will encourage an environment of fun and learning

for the children involved. Will occasionally provide students with assistance during written and/or oral lessons.

May be called upon to assist on monthly group trail rides, which will require some riding skills. Minimum age of 18

and at least one years experience working around horses with a verifiable knowledge of horse behavior and safe

techniques in handling and riding as demonstrated to the Program Director. Experience with children is preferred.

Length of commitment: A minimum of 3 months.

Time Requirement: A minimum of 1 day a week for a minimum of 2 hours according to the program schedule.

Volunteer must be able to provide a fingerprint clearance card. Volunteer Ranch Hand – Will assist in maintaining a clean and safe environment at the barn where

the children receive therapeutic horsemanship training and outdoor education. Specific duties include general

barn maintenance such as stall cleaning, feeding and watering of horses, some light grooming duties if

appropriate, other light barn chores such as sweeping or cleaning tack or equipment.

Length of commitment: A minimum of 3 months.

Time Requirement: A minimum of 1 day a week for a minimum of 2-3 hours. Fundraiser – Focuses mainly on sharing the story of Sunshine Acres with interested individuals/groups and

letting them know about the special mission of the horse program in particular and how they can help. This may

involve some public speaking and/or manning our table at special events throughout the year. Must enjoy talking

with people, sharing information, and sharing our vision.

Photographer/Memory Maker – Focuses on “recording” the ongoing story of the horse program and

telling that story through photographs, book making, Annual Two Hearts Calendar, etc.

Field Trip Planner – Focuses on organizing and executing special educational trips for our children to

locations around the valley to such places as veterinary hospitals, breeding farms, rescue operations, etc.

Handyman – Focuses on doing various odd jobs, making repairs and doing special projects around the barn

area as necessary. Must enjoy working with your hands and fixing things!!

Musician – will be asked to play guitar (or other instruments) and lead praise and worship for various events

throughout the year such as monthly Volunteer Focus Meetings (Saturdays) and various ‘Round the Fire

Gatherings (evenings). Page 1 of 2

Grooming/Clipping – Focuses on keeping our horses looking clean and clipped. Must be willing to pull

manes, clip muzzles and bridle paths, give an occasional soap bath, assist in getting horses ready for special

events such as parades, Board Banquet, annual BBQ event and horse shows.

Audio/Visual Specialist – Focuses on recording activities, special events, and personal stories for

purposes of video archiving and preparation for creating a Two Hearts Horsemanship AV presentation.

Office Assistance – Focuses on general secretarial support for the Director of the Two Hearts

Horsemanship program. General responsibilities would include filing, making phone calls, light typing, etc.

Prayer Team – Focuses on praying for the specific needs of the program as well as the horses, children and

volunteers within the program.

Green Thumb – Focuses on the beautification of our barn facilities by planting and overseeing the care of

seasonal flowers, shrubs, trees, etc. Will generally help maintain the attractiveness and welcoming atmosphere

of the front area of the barn and duties may occasionally including weeding and light tree trimming

Chaperone – Focuses on keeping the kids wrangled up at various events we attend throughout the year.

May be asked to participate in parades as a side-walker, pair up with an individual child at a horse show event,

and must be willing to go with us on some of the various field-trips we plan on taking each year. Must have eyes

in the back of your head!! Volunteer must be able to provide a fingerprint clearance card. Chuck Wagon Gang – Focuses on keepin’ folks fed!! These special people would provide vittles for

some of the workgroups that serve in the horse program throughout the year. No fancy skills needed. Just a

heart for servin’, and a love for cookin’, and enjoys keepin’ a bunch of hardworkin’ people happy by serving up a

hot meal!!

Seamstress – Focuses on helping us make costumes for the kids and horses for both fun and show

purposes. May also be called upon to occasionally clean and alter show clothes

Magician – Able to pull rabbit out of a hat and perform other extraordinary feats upon request. No questions

asked!!

You, the volunteer, are critical to this organization in providing services to the program and the children we are called upon to serve here. If you can dedicate yourself to the requirements and philosophy of this program, we guarantee an experience in learning

and sharing that will enrich your life forever. Page 2 of 2

Two Hearts Horsemanship Program Questionnaire (page 1): How did you hear about the Two Hearts Horsemanship Program at Sunshine Acres? Why would you like to be a Two Hearts Volunteer? As a volunteer, what do you think are your strengths?

Two Hearts Horsemanship Program Questionnaire (page 2): Of the skills you possess, which would you like to offer to the program? Sunshine Acres is a faith-based organization with a non-denominational Christian heritage and Christian values. How do you feel about that?

Two Hearts Horsemanship Program Questionnaire (page 3): Tell us more about yourself including interesting facts, outstanding talents, funny stories, favorite foods, hobbies, certifications, awards, achievements, etc. If you would like, feel free to paste a picture of yourself below.

Please mail or bring this survey to: Sunshine Acres Children’s Home

Two Hearts Horsemanship Program 3405 N. Higley Road

Mesa, AZ 85215

VOLUNTEER APPLICATION (Please print legibly)

Your Name ________________________________________ Application Date _____________

Address _____________________________________________________________________

City __________________________ State _______________________ Zip ______________

Phone _____________________________ Date of Birth ______________________________

Email Address (Please print legibly) _______________________________________________________

Residence: Year Around ____ Seasonal ____ (Arrival Date _____________ Depart Date ____________

PERSON TO CONTACT IN CASE OF EMERGENCY

Name ________________________________________ Relationship _______________________________

Address _________________________________City __________________State__________Zip___________

Contact Phone Numbers 1st_____________________________ 2nd ___________________________________

NOTE: You must exclude yourself from any duties requested of you that you are physically unable to perform.

If you are a SERVICE LEARNING STUDENT please complete the following

Name of School ____________________________________ Course ____________________________________

Name of Professor __________________________________ Phone Number _____________________________

Number of Hours Required __________ What is required by your professor upon completion of your service learning

hours? ______________________________________________________________________________________

VOLUNTEER INTERESTS

1. ______ Boutique (Cashier, sales assistant, clean and repair merchandise, organize, boutique cleaning & stocking)

2. ______ Dining Hall (Prep food, organize supplies, wash dishes, general cleaning) Food Handler’s Card? _____

3. _____** Hairdresser (Cut hair monthly per pre-assigned schedule, clean and sweep salon as needed) 4. _____** Horse Program (Session Instructor, clean stalls/barn, groom animals, raise funds, miscellaneous duties)

5. ______ Maintenance (Electrical, mechanical, plumbing, painting, construction, landscaping)

6. ______ Office (Answer phones, forward calls, schedule tours and pick ups, greet guests, miscellaneous cleaning)

7. _____** School (Classroom assistant, tutor or homework aide, elective instructor and/or assistant)

8. ______ Special Events (Annual Optimist BBQ, Annual Golf Tournament, Raise Funds)

9. ______ Warehouse (Sort, organize, sales assistant, receive donations, move furniture, assist customers)

**These areas may require a Fingerprint Clearance Card. Are you willing to pay all ____; or part of the cost? ____

Days/Hours Available (Select all days that apply and give specific hours you will be available)

___________ Morning ____________ Afternoon ____________ All Day

______Mon ______Tues ______Wed ______ Thurs ______ Friday ______Saturday ______Sunday

3405NORTHHIGLEYROAD, MESA, ARIZONA85215 (480)832‐2540 FAX(480) 832‐2041

Confidentiality Policy

As a volunteer at Sunshine Acres Children’s Home, I understand that I must, in accordance with Sunshine Acres Children’s Home volunteer policies and DES regulations abide by the same child confidentiality and professional standards as paid staff. Contact between the child and Sunshine Acres Children’s Home is a highly privileged and confidential relationship, and it is the responsibility of staff (paid and unpaid) to hold in absolute confidence any and all information concerning a child.

_______ All information regarding admitted children of Sunshine Acres Children’s Home of

Initial Mesa, Arizona, and/or their parents, family, legal guardians, or those charged with their

care, is confidential and shall be treated as such, and shall not be divulged to

unauthorized personnel.

_______ All information regarding employees of Sunshine Acres Children’s Home of Mesa,

Initial Arizona, and/or family, is confidential and shall be treated as such, and shall not be

divulged to unauthorized personnel.

_______ Employees or volunteers found to be in violation of this policy may have their

Initial relationship with Sunshine Acres terminated.

Volunteer Pledge

Believing that Sunshine Acres Children’s Home has a real need of my services as a volunteer, I will be punctual and conscientious in the fulfillment of my duties and accept supervision gracefully. I will conduct myself with dignity, courtesy, and consideration. I will consider as confidential all information which I may hear directly concerning a child, house parent or any member of the staff, and will not seek confidential information in regard to a child. I will take any problems, criticisms or suggestions to the Volunteer Coordinator. I will uphold the Christian Mission Culture and standard of excellence of Sunshine Acres Children’s Home and will interpret them to the community at large.

Volunteer Disclaimer

I understand that I participate as a volunteer at Sunshine Acres Children’s Home at my own risk. In the event of an injury, I personally accept responsibility for the full expense of medical attention as well as other expenses arising out of such injury. Some projects may have inherent risks associated with them, and I personally accept responsibility to know what risks and I will not undertake any activity that may be too high a level of risk for my capabilities. I further agree to release and hold Sunshine Acres Children’s Home, its Board of Trustees, officers, employees and unpaid staff harmless from and against all losses from claims or liabilities for personal damages or other damages incurred as a result of my participation as a volunteer, whether or not they result from Sunshine Acres Children’s Home’s negligence. I understand that I am not an employee of Sunshine Acres Children’s Home and shall not be eligible for, or covered under, any benefit program maintained by the Sunshine Acres Children’s Home including but not limited to worker's compensation, health insurance, disability, and business travel accident coverage. By signing below I certify that I have read, understand and agree to comply with the above statements.

Signed __________________________________________ Date __________________

3405 NORTH HIGLEY ROAD, MESA, ARIZONA 85215 (480) 832-2540 FAX (480) 832-2041

SKILLS – INTERESTS – EDUCATION

Name __________________________ Please share your hobbies and interests as well as areas in which you have educational, professional, or life experiences in which you desire to share your skills. Indicate your skill level by using: (A) – very skilled, (B) – moderately skilled. ____ Antiques/Collectables ____ Landscaping ____ Art ____ Math - basic ______ higher math _______ ____ Calligraphy ____ Mechanics ____ Carpentry ____ Music (vocal/instrumental) ____ Clerical Skills ____ Organizing ____ Computer Skills (Mac, PC, Software) ____ Painting ____ Cooking ____ Photography ____ CPR/First Aid ____ Plumbing ____ Crafts ____ Public Speaking ____ Decorating ____ Reading - grade proficiency ____________ ____ Drama/Dance ____ Sales (Retail, Wholesale) ____ Electrical ____ Scrapbooking ____ Event Planning ____ Sewing ____ Floral Design ____ Typing ____ Furniture Repairs and/or Building ____ Upholstery ____ Gardening ____ Weaving ____ Grant Writing ____ Writing – grade proficiency _____________

____ Other _________________________________________________ Education: ____________________________________________________________________ Experience with: (Mark all that apply.) ____ Preschoolers ____ Junior High School ____ Elementary School ____ Teenagers ____ High School ____ Learning Disabled What do you picture yourself doing when you volunteer at Sunshine Acres Children’s Home? (Please exclude yourself from any activities you believe to be physically stressful for you.) Additional information or comments you wish to share -- (You may use this space for more details about your specific skills/interests):


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ARIZONA

EQUINELIABILITYRELEASEANDASSUMPTIONOFRISKAGREEMENT

(Pleasereadthefollowingthree(3)pages.Completeallrequiredfieldsandsign/datethebottomofpagethree)

I/WE:

• AcknowledgethatI/Wehavebeeninformedofseveralinherentrisksassociatedwithequineactivities(meaningdangerorconditionthatisanintegralpartofanequineactivity),including,butnotlimitedtoanyofthefollowing:

a. Thepropensityofanequinetobehaveinwaysthatmayresultininjury,deathorlosstopersonsonoraroundtheequine;

b. Theunpredictabilityofanequine’sreactiontosounds,suddenmovement,unfamiliarobjects,persons,orotheranimals;

c. Hazards,including,butnotlimitedto,surfaceorsubsurfaceconditions;

d. Acollisionwithanotherequine,anotheranimal,aperson,oranobject;

e. Thepotentialofanequineactivityparticipantorotherpersons,includingbutnotlimitedto,failingtomaintaincontroloveranequineorfailingtoactwithintheabilityoftheparticipant.

• AcknowledgethatI/Weareawareoftheinherentrisksofequineactivities.

• AffirmthatI/Wearewillingandabletoacceptfullresponsibilitiesformy/ourownsafetyandwelfare.

• AgreethatI/Wearereleasingtheequineowneroragent(orothersaffiliatedwiththem)fromliabilityunlesstheowneroragentisgrosslynegligentorcommitswillful,wanton,orintentionalactsoromissions.

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EQUINERIDINGand/orDRIVINGand/orTRAININGINSTRUCTIONAGREEMENT,LIABILITYRELEASEANDASSUMPTIONOFRISKAGREEMENT[FORINDIVIDUALS]

SunshineAcresChildren’sHome_________________________________________________________________________________

STABLENAME,hereinafterknownas"THISSTABLE."

3405N. HigleyRoad,Mesa,AZ85215_________________________________________________________________________________

LocationorAddressofTHISSTABLE

READCAREFULLYANDCOMPLETEALLSECTIONSBEFORESIGNING.

A.REGISTRATIONOFPARTICIPANTANDAGREEMENTPURPOSE I,thefollowinglistedindividual,andtheparentsorlegalguardiansthereofifaminor,doherebyvoluntarilyagreetoparticipantinequinerelatedinstructionofTHISSTABLE,andthatIwilleitherutilizemyownhorseorschoolhorsesprovidedbyTHISSTABLEforinstructionpurposes.

PARTICIPANTNAME(pleaseprint)

AGE(Ifunder18) WEIGHTOver240#?

HORSEHANDLING/RIDINGEXPERIENCE(Checkonethatapplies)

1. 2.Age________3.DateofBirth_______

4._______YES_______NO

5._______BEGINNER(under10hours)_______OVER10HOURS

6.Doesparticipanthaveanyphysicalormentalcondition(s),whichmayaffecthis/hersafetyandabilitytoride,driveand/ortrainahorse?YesNo(CircleOne)7.Ifyoucircled“YES,”howcanwehelpparticipantwithhis/herspecialneeds?

8.MEDICALINSURANCEI/WEAGREETHAT:Shouldmedicaltreatmentberequired,Iand/ormymedicalinsurancecompanyshallpayforALLsuchincurredexpenses.

Mymedicalinsurancecompanyis___________________________Mypolicynumberis______________________________❏ Idonotcarrymedicalinsurance.

B.AGREEMENTSCOPEANDTERRITORYANDDEFINITIONS Thisagreementshallbe legallybindinguponmethe registeredparticipant,and theparentsor legalguardiansthereofifaminor,myheirs,estate,assigns,includingallminorchildren,andpersonalrepresentatives;anditshallbeinterpretedaccordingtothelawsofthestateandcountyofTHISSTABLE'S physical location.Thisagreement is intended tobevalidandbindingatall timesnowand in the futurewhenTHISSTABLEpermitsme(directlyorindirectly)toenterTHISSTABLE’Sproperty,beonTHISSTABLE’Sproperty,benearanyhorse,receiveridingand/ordrivingand/ortraininginstructionorguidancefromitsassociatesand/orwhenIrideand/ordriveand/ortrainand/oramnearhorsesonoroffofTHISSTABLE’Sproperty.Anydisputesbytheridershallbelitigatedin,andvenueshallbethecountyinwhichTHISSTABLEisphysicallylocated.Thisagreementisintendedtobeasbroadandinclusiveasthelawpermits.Ifanyclause,phrase,orwordisinconflictwithstatelaw,thenthatsinglepartisnullandvoid.Theterms"HORSE"and“EQUINE”hereinshallrefertoallequinespecies.Theterms"I",“WE”,"ME","MY"shallhereinrefertotheaboveregisteredparticipantandtheparentsorlegalguardiansthereofifaminor.

C. INHERENTRISKS/ASSUMPTIONOFRISKS I /WEACKNOWLEDGETHAT: Risks, conditions,anddangersare inherent in (meaningan integralpartof)horse/equine/animalactivities,regardlessofallfeasiblesafetymeasureswhichcanbetaken,andIagreetoassumethem.Theinherentrisksinclude,butarenotlimitedtoany 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; Theunpredictabilityofanequine’sreactiontosoundssudden,movement,unfamiliarobjects,persons,orotheranimals;Hazards,including,butnotlimitedto,surfaceorsubsurfaceconditions;Acollision,encounterand/orconfrontationwithanotherequine,anotheranimal,aperson,oranobject;Thepotentialofanequineactivityparticipanttoactinanegligentmannerthatmaycontributetoinjury,harm,death,orlosstotheparticipantortootherpersons,includingbutnotlimitedto,failingtomaintaincontroloveranequineand/orfailingtoactwithintheabilityoftheparticipant.Horsesare5to15timeslarger,20to40timesmorepowerful,and3to4timesfasterthanahuman.Ifariderfallsfromhorsetogrounditwillgenerallybeatadistanceoffrom31/2to51/2feet,andtheimpactmayresultinharmtotherider.Horsebackriding,drivingandtrainingareactivitiesinwhichonemuchsmaller,weakerpredatoranimal(thehuman)triestoimposeitswillonandbecomeoneunitofmovementwith,anothermuchlarger,strongerpreyanimalthathasamindofitsown(thehorse)andeachhasalimitedunderstandingoftheother. Ifahorseisfrightenedorprovokeditmaydivertfromitstrainingandactaccordingtoitsnaturalsurvivalinstinctswhichmayinclude,butarenotlimitedto:Stoppingshort; Spinning around; Changing directions and / or speed at will; Shifting its weight; Bucking; Rearing; Kicking; Biting; and / or Running from danger. I alsoacknowledgethatthesearejustsomeoftherisksandIagreetoassumeothersnotmentionedabove.IamnotrelyingonTHISSTABLEtolistallpossiblerisksforme.

D. CONDITIONSOFNATUREWARNING,UNFAMILIARAND SUDDEN SIGHTS, SOUNDSANDMOVEMENTSWARNING, AND INSPECTIONOF PREMISES I /WEACKNOWLEDGETHAT:THISSTABLEisNOTresponsiblefortotalorpartialacts,occurrences,orelementsofnatureand/orsuddenand/orunfamiliarsights,soundsand/orsuddenmovementsthatcanscareahorse,causeittofall,orreactinsomeotherunsafeway.SOMEEXAMPLESARE:Thunder,lightening,rain,wind,wildanddomesticanimals,Insects,reptiles,whichmaywalk,run,orflynear,orbiteorstingahorseorperson;andirregularfootingonout‐of‐doorgroomedorwildlandwhichissubjecttoconstantchangeinconditionaccordingtoweather,temperature,andnaturalandman‐madechangesinlandscape.Ialsounderstandthattheseare just someof the risks and I agree to assumeothers notmentioned above. I amnot relying on THIS STABLE to list all possible conditions forme. TheparticipantandparentorlegalguardianhaveinspectedTHISSTABLE'Sfacilitiesandaresatisfiedthatallpremiseconditionsarereasonablysafeforthisparticipant’sintendedpurpose,usageandpresenceuponTHISSTABLE'Spremises.

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E.SADDLEGIRTHS/NATURALLOOSENINGWARNING I /WEACKNOWLEDGETHAT: Saddlegirths (fastenerstrapsaroundhorse'sbelly)may loosenduringriding.Participantsmustalerttheinstructororattendantofanygirthloosenesssoactioncanbetakentoavoidslippageofsaddleandthepotentialfortheridertofallfromthehorse.

F.PROTECTIVEHEADGEAR/HELMETWARNING I /WEAGREETHAT: Iformyselfandonbehalfofmychildand/orlegalwardhavebeenfullywarnedandadvisedbyTHISSTABLEthatprotectiveheadgear/helmet,whichmeetsorexceedsthequalitystandardsoftheSEICERTIFIEDASTMSTANDARDF1163EquestrianHelmet,shouldbewornwhileridingand/ordrivingand/ortrainingand/orbeingnearhorses,andIunderstandthatthewearingofsuchheadgear/helmetatthesetimesmayreduceseverityofsomeofthewearer'sheadinjuriesandpossiblypreventthewearer'sdeathfromhappeningastheresultofafallandotheroccurrences.IamnotrelyingonTHISSTABLEand/oritsassociatestoprovideacertifiedhelmetformeortocheckanyheadgear/helmetorheadgear/helmetstrapthatImaywear,ortomonitormycompliancewiththissuggestionatanytimenoworinthefuture.

G.LIABILITYRELEASE I /WEAGREETHAT: InconsiderationofTHISSTABLEallowingmyparticipation in this activity,under the termsset forthherein, I, thePARTICIPANT, formyself and on behalf ofmy child and / or legalward, heirs, administrators, personal representatives or assigns, do agree to release, holdharmless, and discharge THIS STABLE, its owners, agents, employees, officers, directors, representatives, assigns, members, owners of premises and trails,affiliatedorganizations, and Insurers,andothersactingon theirbehalf (hereinafter, collectively referred toas"Associates"),of and fromall claims,demands,causesofactionandlegalliability,whetherthesamebeknownorunknown,anticipatedorunanticipated,duetoTHISSTABLE'Sand/orITSASSOCIATE’Sordinarynegligenceorlegalliability;andIdofurtheragreethatexceptintheeventofTHISSTABLE'Sgrossnegligenceand/orwillfuland/orwantonmisconduct,Ishallnotbringanyclaims,demands,legalactionsandcausesofaction,againstTHISSTABLEandITSASSOCIATESasstatedaboveinthisclause,foranyeconomicandnon‐economic lossesdue to bodily injuryand/ordeathand/orpropertydamage, sustainedbymeand/ormyminorchildor legalward in relation to thepremises and operations of THIS STABLE, to includewhile riding, driving, training, handling, or otherwise being near horses owned bymeorowned by THISSTABLE,orinthecare,custodyorcontrolofTHISSTABLE,whetheronoroffthepremisesofTHISSTABLE,butnotlimitedtobeingonTHISSTABLE’Spremises.

H.EQUINEACTIVITYLIABILITYACT[EALA]WARNINGORLANGUAGE:[Thisclauseappliesonlyforoperationslocatedinthesestates:AL,AZ,CO,DE,FL,GA,IL,IA,IN,KY,KS, LA,ME,MA,MI,MS,MO,NE,NC,OH,OK,OR,RI,SC,SD,TX,TN,UT,VA,VT,WV,andWI.] I /WEacknowledge that Ihave reviewedthis state’sEQUINEACTIVITYLIABILITYACTWARNINGORLANGUAGE,acopyofwhich isattachedheretoand incorporatedas if fully set forthherein. INSTRUCTION TOSIGNERS:DONOTSIGNUNLESSACOPYOFTHEEALAWARNINGORLANGUAGEISATTACHEDTOTHISAGREEMENT.

AllParticipantsandParentsorLegalGuardiansmustsignbelowafterreadingthisentiredocument.

SIGNERSTATEMENTOFAWARENESSI/WE,THEUNDERSIGNED,REPRESENTTHATI/WEHAVEREADANDDOUNDERSTANDTHEFOREGOINGAGREEMENT,LIABILITYRELEASEANDASSUMPTIONOFRISKAGREEMENT,I/WEUNDERSTANDTHATBYSIGNINGTHISDOCUMENTIAMGIVINGUPRIGHTSTOSUETODAYANDINTHEFUTURE.I/WEATTESTTHATALLFACTSARETRUEANDACCURATE.IAMSIGNINGTHISWHILEOFSOUNDMINDANDNOTSUFFERINGFROMSHOCK,ORUNDERTHEINFLUENCEOFALCOHOL,DRUGSORINTOXICANTS.

_______________________________________________________________________________________________________________________________________SIGNATUREOFPARTICIPANT(Spousesmustsignforthemselves.) DATE

____________________________________________________________________________________________________________________________________SIGNATUREOFPARENT,GUARDIANAND/ORSPOUSE#1DATESIGNATUREOFPARENT,GUARDIANAND/ORSPOUSE#2DATE

AddressInFull______________________________________________________________HomePhone#___________________Bus.Phone#___________________________________________________________________________________________________________________________()______________________PERSONTOCONTACTINCASEOFEMERGENCYRELATIONSHIPTOPARTICIPANTPHONENUMBER

HAVEYOUREADALLTHREEPAGESOFTHE

EQUINELIABILITYRELEASEANDASSUMPTIONOFRISKAGREEMENT,

COMPLETEDALLREQUIREDFIELDSONPAGETWO&THREE

ANDSIGNED/DATEDATTHEBOTTOMOFPAGETHREE?

REFERENCE (Applicant: Please include three (3) completed references with your application)

Applicant Name ____________________________ Phone _______________Date __________

Reference Name _________________________________ Phone _______________________

Address _____________________________________________________________________

Relationship to Applicant __________________________ Number of years known __________ 1. Which of the following best describes your perception of the person? (Please circle all that apply)

Cooperative Cheerful Leader Hostile Responsible

Aggressive Trustworthy Critical Bossy Domineering

Follower Quiet/Reserved Helpful Organized Optimistic

Passive Talks too much Pleasant Anxious Doesn’t talk much

Takes initiative Follows directions Creative Enthusiastic Dependable

2. Have you ever observed the applicant interacting with children? YES NO If yes, please circle all that apply. If no, please skip to the next question.

Patient Nurturing Friendly Respectful Critical

Playful Permissive Abusive Gentle Controlling

Yells Energetic Attentive

- Please circle if you have observed either or both of the following.

Inappropriately affectionate Inappropriately expressing anger

- If either or both are circled, please describe what you have observed.

3. How do you rate the applicant to follow through with his or her commitments? Please give specific examples. 4. Have you ever known the person to be involved with any of the following? (Please circle any that apply.)

Addiction or abuse of alcohol, prescription or illegal drugs,

Attempted suicide Criminal conviction

5. Sunshine Acres Children’s Home is a faith-based organization providing a loving, wholesome, Christian home for children. Will the applicant model and support the traditional Biblical guidelines for conduct, relationships, sexuality and marriage for kids? Yes_____ No_____ 6. If you have any reservation about this person working with any of the following groups of children, please circle all that apply.

Elementary-aged children Junior High School age children

Teenagers in High School Your own child

7. What else is important for Sunshine Acres Children’s Home to know about the applicant, positive and/or negative?


Sunshine Children’s Home Volunteer Application … Acres Children’s Home Volunteer Application...

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