Safe Haven Equine Rescue & Retirement
129 Asbill Ave.
High Point, NC 27265
336-688-2249 / 336-884-2007
Volunteer & Liability Waiver Form
Please complete entire form, sign and return via email to or US mail to address above. Completed and signed application must be on file before any volunteer work can begin.
CONTACT INFORMATION: P L E A S E P R I N T
Volunteer Name: ______Birth Date:______
Address:______City/State/Zip______
Home/Work Phone: ______Cell Phone: ______
Email: ______
Occupation: ______
Additional experience/skills/talents you have that you wish to share with Safe Haven Rescue:
______
Parent/Legal Guardian Name (for volunteers under 18):
Relationship: ______
Address:______City/State/Zip:______
Home/Work Phone:______Cell Phone:______
Email: ______
AVAILABILITY TO VOLUNTEER:
Farm Hours weekdays 9am – 12pm and 5:30pm – 9:00pm Weekends 8 am to 5 pm
Mon _____ Tue_____ Wed_____ Thu _____ Fri _____ Sat _____ Sun_____
Times available:______Hours per visit______
Other______
HORSE EXPERIENCE:
Number of years working with horses: ______
*Leading/grooming______*Training on the ground______*Training under saddle______
*Working with green horses______*Working with unbroken horses ______
*Stall mucking ______*Full care/maintenance of a horse ______
If you need more space for these questions, please use the back.
Describe your horse experience: ______
Why do you want to volunteer at SHERR? ______
Have you ever done volunteer work before? ______Where? ______How long? ___
WHICH AREAS WOULD YOU ENJOY PARTICIPATING IN MOST:
No Experience Necessary:
Barn chores ______AM feeding and turnout______PM feeding and turnout______
Fundraising events ______SHERR booths at fairs / shows______Distributing materials______
Previous Experience Necessary:
REQUIRES EVALUATION AND INTERVIEW:
Training horses ______Girl Scout program ______
Grant writing / PR______Computer support ______Handyman / maintenance______
Educational programs ______
Training is available the above volunteer opportunities. Check with SHERR Staff if you are interested.
MUST CONTAIN ORIGINAL SIGNATURE:
Signature: ______Date: ______
(Volunteer or Parent/Guardian if under 18)
Volunteers under 18 May Not Start Volunteering without Parent/Guardian Signature
Safe Haven Equine Rescue & Retirement
VOLUNTEER LIABILITY WAIVER & RELEASE
By this agreement, made and entered this ____ day of _____, 20___, by and between______, who resides at ______, andSafe Haven Equine Rescue & Retirementand the facility located at 245 Cedar Ridge Lane, High Point, NCherein referred to as “The Stable”.
It is hereby agreed to as follows:
- That I, the undersigned, do for myself or on behalf of my child or legal ward, hereby request to participate in activities as a volunteer.
- That the parent/guardian and volunteer understands that horses are unpredictable by nature: that when frightened or angry or under stress, a horses natural instincts are to jump forward or sideways, to run away from danger at high speeds, to kick, to jump, to back up, to rear up on their hind legs, to bite, that horses are extremely powerful; and that if a rider falls from a horses back to the ground, the fall distance will generally be between 3 ½ - 5 ½ feet. I can get stepped on or knocked down. I understand these risks and, voluntarily assume these risks and dangers.
- That the parent/guardian and volunteer understands that hereafter upon mounting a horse or solely handling a horse from the ground, that the volunteer is in primary control of the horse and that neither Safe Haven Equine Rescue & Retirement, nor the other volunteers, employees, boarders, visitors or patrons are responsible for the volunteers actions or inactions. The volunteer further agrees not to abuse or misuse, or deliberately agitate the horse as these actions may result in an increased risk to himself/herself and others.
- That I have been told that all volunteers under the age of 18 doing any riding must wear an approved safety helmet. I have been advised that it is recommended that ALL riders wear helmets.
5.Liability Release: That I understand that I am responsible for bodily injury or property damage which I or my child/legal ward should sustain on Safe Haven Equine Rescue & Retirement premises and/or neighboring properties and/or trails and/or while riding or handling a horse, and/or while in transit to horse shows, trail rides, fundraising events or other similar expeditions, and for any time I or my legal ward/child shall lose from employment or school or any other activity, and for medical expenses or any other expenses incurred because of such bodily injury or property damage. I am aware that I should have my own health and/or accident insurance. That I hereby, for myself, my heirs, administrators, and assigns release and discharge the owners, operators, managers, instructors, boarders, staff, sponsors, insurance companies, volunteers, guests, patrons, and all other participants of Safe Haven Equine Rescue & Retirement from all claims, demands, actions, and causes of action for such injuries sustained to my person, or that of my child or legal charge and/or property. I understand that while I/my child is volunteering on the property – due to the nature of a barn and the surrounding environment – that there is the possibility of coming in contact with poisonous snakes and/or spiders, or being around rusty fencing, nails, wood splinters, etc. and that I am releasing Safe Haven Equine Rescue & Retirement and the facilitie located at 245 Cedar Ridge Lane, High Point, NC, the owners, their insurance carriers, volunteers, and organizers should I become injured in any way due to such circumstances.
Under North Carolina Law, an equine activity sponsor or equine is not liable for injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina general statutes
Please print all information except for signature
Name of Volunteer______
Name of Parent/Legal Guardian______
______
Signature of Volunteer or Parent/Legal Guardian Date