Volunteer Application (for individuals) Name* First Last Mailing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Home or Alternative PhoneEmail* Date of Birth* MM slash DD slash YYYY How did you hear about volunteer opportunities with the Greenwell Foundation? (Check all that apply) By a friend Facebook Website Flyer Please share the name of your friend that told you about Greenwell Foundation's volunteer opportunities. Are you a veteran? What days and times are best for you?Please indicate which area you are interested in volunteering:* In Arena - Assisting with riding lessons (Side Walking/Horse Leading) Do you have any experience with horses?* Yes No If yes, please describe your experience with horses:*Do you have any experience working with individuals with special needs?* Yes No If yes, please describe your experience with individuals with special needs:*Do you have any medical conditions?* Yes No If yes, please explain.*Emergency Contact Name:* Emergency Contact Phone:* Relationship (friend, parent, etc.):* Photo Release: By entering my name in the field below, I hereby acknowledge that photographs taken of my child/myself by the Greenwell Foundation may be used for promotional purposes unless written notification is submitted. Volunteers must seek staff permission before taking any pictures or videos.* Background Check: By entering my name in the field below, I understand that I may need to undergo a background screening.* Liability release: By entering my name in the field below, I agree to the following (as either the volunteer or parent/guardian of minor): In consideration of participation in the activities and programs of the Greenwell Foundation/DNR I do hereby forever release the Greenwell Foundation and the Maryland Department of Natural Resources (DNR), their officers, directors, advisors, supervisors, instructors, staff, and members, from any and all claims, demands, suits, or liabilities which might otherwise arise by virtue of any injury which may occur to myself. I further agree to indemnify and hold harmless each and everyone of them from any and all claims, demands, suits, or liabilities which might otherwise arise by virtue of injury by myself or any horse under my direction of control or ownership.* Consent to Treat: By entering my name in the field below, I do authorize any officer, director, advisor, or supervisory personnel of the Greenwell Foundation and/or the Department of Natural Resources, to consent on my/our behalf, in our absence, to any emergency medical treatment which may be required for myself, or the Minor volunteer and do agree to indemnify and hold harmless anyone giving such consent. I acknowledge that we have been informed and understand the inherent risks related to volunteer opportunities offered by both the Greenwell Foundation and the DNR.* Confidentiality Policy: Greenwell Foundation places great importance on protecting the confidential information of our clients, our staff and our volunteers. "Confidential Information" includes, but is not limited to, personally identifiable information such as surnames, telephone numbers, addresses, e-mails, etc., as well as the non-public business records of Greenwell Foundation. In particular, medical information about clients, and information about their disabilities or special needs, must be protected as Confidential Information. Volunteers shall never disclose Confidential Information to anyone other than Greenwell Foundation staff. I have read and understand the Greenwell Foundation Confidentiality Policy and agree to abide by the same.* CommentsThis field is for validation purposes and should be left unchanged.
