NCEFT National Center for Equine Facilitated Therapy

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Volunteer Application

Volunteer Application

Volunteer Application

Step 1 of 4 – Contact Information

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Contact Information
First Name (of Participant)*
Nickname or Preferred Name*
Last Name (of Particpant)*
Pronouns*
- He/Him
- She/Her
- They/Them
Occupation*
Birthday*
MM slash DD slash YYYY
Age*
Minor/Applicant Email*
Email*
Minor/Applicant Cell Phone*
Minor/Applicant Preferred Contact Method*
- Call
- Email
- Text
Parent/Guardian Name*
Parent/Guardian Email*
Parent/Guardian Cell Phone:*
Parent/Guardian Home/Alternate Phone Number:
Parent/Guardian Preferred Contact Method*
- Call
- Email
- Text
Parent/Guardian Address*
Street Address Apt # City State ZIP Code
Cell Phone:*
Home/Alternate Phone Number:
Preferred Contact Method*
- Call
- Email
- Text
Address*
Street Address Apt # City State ZIP Code

Schedule and Experience
Covid-19 Vaccination Status*
Please understand that for the safety of our clients, only those vaccinated or planning to be vaccinated will be eligible to volunteer at NCEFT.
- I am fully vaccinated and boosted
- I plan to be fully vaccinated and boosted before I start volunteering at NCEFT
Please indicate which volunteer role(s) you are interested in.*
- Side-Walking (ages 16+)
- Facilities/Gardening
- Special Events Volunteer
- Office Help
- Barn Help
- Mental Health and Resilience program volunteer
Please let us know about any special skills that could be helpful to us, such as:*
- Data Entry / Database
- Graphic design (advanced)
- Web Design (WordPress)
- PowerPoint presentations (advanced)
- Grant writing
- Fundraising
- Marketing
- Social media expert
- Event planning
- Professional Photography
- Professional Videography
- Film Making (intermediate – advanced)
- First-aid certified
- Spanish speaking
- Arts & crafts
- Groom & tack
- N/A
- Other
Please let us know about your other skills.*
Horse experience*
- No Horse Experience
- Groom
- Tack
- Ride
Years of horse experience, and briefly summarize your experience.*
Are you comfortable working independently around horses?*
- Yes
- No
Athletic Ability for Side-Walking (if you are unable to select Yes for both questions below, please select a different volunteer role)*
Side-walkers walk beside the horse for the entire session (30 minutes), maintaining the safety of the patient/client at all times. Side-walkers must be able to bend, twist, and raise arms to shoulder height, and occasionally jog/run for short distances on uneven ground and lift up to 35lbs. A Fit Test is required for this role.
- Yes, I am able to jog/run for short distances on uneven ground.
- Yes, I can lift up to 35 lbs.
Height*
Schedule Type*
- I am available weekly (2-hour max time commitment daily)
- I am available on-call
- I am available during the summer only
Please indicate your availability to side-walk during morning sessions (10am-12pm)*
- N/A
- Mondays
- Tuesdays
- Wednesdays
- Thursdays
- Fridays
Please indicate your availability to side-walk during afternoon sessions (1-3pm)*
- N/A
- Mondays
- Tuesdays
- Wednesdays
- Thursdays
- Fridays
Please indicate your availability to side-walk during evening sessions (3-5pm)*
- N/A
- Mondays
- Tuesdays
- Wednesdays
- Thursdays
- Fridays
Your Availability (for roles other than Side-Walking)*
NCEFT is open Monday-Friday from 10am-5pm. Please let us know your availability to volunteer during these times.
How did you hear about NCEFT, and why do you want to volunteer with us?*
Do you have previous experience with children or adults with disabilities? (not required for volunteering)*
Tell us about the other places you currently or previously volunteered with, and in what capacity?*
If applicable, does your employer offer a matching donation program, or volunteer program? If so, please enter the employer's name and contact information.*

Consents & Agreements
Background Check Policy*
A background check is required and paid for by NCEFT for volunteers 18+. By checking the box, you agree to a background check if you are 18+.
I consent and agree
Photo and Video Release*
NCEFT has the right to take photos or videos of volunteers for the purpose of promoting, marketing, and creating newsletters without remuneration.
- I consent and agree
- No, do not use my image
General Agreement & Release of Liability*
I (Participant or Parent/Legal Guardian if above named Volunteer Applicant is under the age of 18), hereby acknowledge that I have requested permission to participate and/or volunteer in equestrian assisted activities on and away from the premises of The National Center for Equine Facilitated Therapy (NCEFT). I agree to abide by all rules, written and implied, at NCEFT. I am aware that equine related activities can be hazardous. I am voluntarily participating in these activities with the knowledge of the danger involved and hereby agree to accept any and all risks of injury or death.

In consideration for being permitted to use the facilities at NCEFT and/or participate in any NCEFT programs, I hereby agree that I, my heirs, my distributes, guardians, legal representatives and assignees will not make a claim against, sue, attach the property of or prosecute NCEFT, its directors, officers, members, employees, volunteers or assignees, for any claim I now have or may hereafter have for death, injury or property damage resulting from my use of the facilities at NCEFT or my participation in any NCEFT endorsed activities, whether caused by my acts of omission or negligence or anyone else’s acts of omission or negligence. In addition, it is understood that any and all insurance that I have shall be primary.

To the fullest extent permitted by law, I shall defend, indemnify and hold harmless, NCEFT, its directors, officers, agents, volunteers, or employees for and against any and all claims, damages, losses, expenses and liabilities of any and every kind, including but not limited to attorney’s fees, in any way arising out of or in connection with my activities under this agreement. This indemnity shall apply regardless of any active or passive negligent act or omission of NCEFT, its directors, officers, agents, volunteers and employees.

I have carefully read this agreement and release and fully understand its contents. I am aware that this is a release of liability, a waiver of legal rights and contract between me and NCEFT and sign it of my own free will. I further acknowledge that there are no warranties, either express or implied, concerning the facilities, events or activities at NCEFT.
I consent and agree
Confidentiality Agreement*
All information gathered by and located inpatient charts at NCEFT is considered confidential. Discussions of patient care, personal issues, or medical conditions may only be engaged in on a need-to-know basis and with appropriate persons.

Only with the patient or guardian’s written permission will information be disclosed or released to anyone. Information will be released in the following situations, as required by law and with respect for HIPAA regulations:

Referring physicians and others on a need to know basis will be allowed to view, or given copies of a patient’s medical record when there is:

1. A request for Evaluation and/or progress notes.
2. Any changes which may result in contraindication as related to Equine Facilitated Therapy.
3. Hospitalization following an emergency.
I consent and agree
Signature*
Please type your name in the box below to digitally sign and consent to the Background Check Policy, Photo and Video Release, General Agreement & Release of Liability, and Confidentiality Agreement. By completing this question with my typed name or typed name of my legal representative, I am consenting to and authorizing my typed name to be the electronic representation of my signature and initials for all purposes when I (or my agent) use them on my document, including legally binding contracts – just the same as pen-and-paper signature or initial.
Signature of Parent/Guardian of Minor Volunteer*
Please type your name in the box below to digitally sign and consent to the Background Check Policy, Photo and Video Release, and General Agreement & Release of Liability. By completing this question with my typed name or typed name of my legal representative, I am consenting to and authorizing my typed name to be the electronic representation of my signature and initials for all purposes when I (or my agent) use them on my document, including legally binding contracts – just the same as pen-and-paper signature or initial.

Emergency Contact Information
Emergency Contact Name*
Relationship*
Phone*
Emergency Contact's Email*
Address*
Street Address Apt # City State ZIP Code
Physician's Name
Physician's Phone Number
Preferred Medical Facility*
Medical Insurance Company*
Policy/Group Number*
Allergies, medications, and any medical history helpful to know*
Last Tetanus Shot?*
Do you wear contact lenses?*
- Yes
- No
Medical Consent*
I give permission to NCEFT to seek medical care on my behalf in case of emergency.
- I consent and agree
- No, do not seek medical treatment for me in case of emergency
Medical Consent for a Minor*
If emergency medical care is required for Volunteer, who is a minor and if any permission is not available in a timely manner, then the undersigned parent/guardian authorizes appropriate emergency medical care as deemed necessary by emergency medical personal, a physician, or the medical facility providing treatment.
- I consent and agree
- No, do not administer medical treatment
Signature*
I have read and fully understand this volunteer emergency medical release. Please type your name in the box below to digitally sign and consent to the Emergency Medical Release.
Signature of Parent/Guardian of Minor Volunteer*
I have read and fully understand this volunteer emergency medical release. Please type your name in the box below to digitally sign and consent to the Emergency Medical Release.

NCEFT: HORSES. HOPE. HEALING.

Horses. Hope. Healing. Three simple words that when combined have the power to transform lives. NCEFT is centered around helping people. We are about compassion, inclusiveness, and offering the highest level of service to those in need. We do this by harnessing the unique connection between horses and humans. NCEFT is also about community. Many of our clients and families describe NCEFT as a place that feels like home with people who feel like family.

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NCEFT
880 Runnymede Road
Woodside, CA 94062-4132

P: (650) 851-2271
F: (650) 851-3480
E: info@nceft.org

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© 2022 The National Center for Equine Facilitated Therapy. NCEFT is a non-profit 501(c)(3) public benefit corporation established in 1971. Tax ID# 94-2378104.