VOLUNTEER INFORMATION Volunteer First Name: * Volunteer Last Name: * Date of Birth (please use format: mm/dd/yyyy): * Gender (please choose one): * FemaleMaleNon-binary/Third GenderPrefer not to say Allergies (please include risk of anaphylaxsis, need for EpiPen): Home Phone: Mobile Phone: Work Phone: Preferred Phone: * HomeWorkMobileOther Email: * Preferred Method of Contact (please select one): * Text MessageMobile PhoneHome PhoneWork PhonePersonal EmailWork Email Mailing address: * City: * State: * ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDCASGUMPPRUMVIProvinceABBCMBNBNLNSNTNUONPEQCSKYT ZIP: * Semester Available (Please mark the semesters you are available, Fall: 9/1/-1/31, Spring: 2/1-6/30, Summer: 7/1-8/31. To select more than one option, press the CTRL button.): * FallSpringSummerCollege Breaks Only Availability (Please indicate all days/specific times that you are available. Please specify how many days and hours per week you'd like to volunteer): * Do you have previous horse experience? (Please select one): * YesNo Relevant experience (For example: Experience working with children, people with disabilities, # years riding and/or caring for horses): Are you a therapist or a riding instructor? (Please select all that apply. To select more than one option, press the CTRL button.): OTPTSLPMA Licensed Riding InstructorPATH Certified Therapeutic Riding InstructorPATH Certified Equine Specialist in Mental Health and LearningOther School/Day Program (if applicable): Grade (if applicable): Occupation/Title: Employer: Does your company have a matching gift program? (Please select one): YesNo Are you involved with any foundations or corporate giving programs? (Please select one): YesNo Please review the Volunteer Opportunities below and then select all that apply from the Areas of Interest field that follows. Lesson Volunteer: Grooming, tacking and leading a horse (significant horse experience & training required) Sidewalking a rider Horse Care Volunteer: Stall & paddock cleaning Tack cleaning General barn chores (sweeping, watering, etc.) Office Volunteer: Mailings Event Volunteer: Event planning Bake/cook Work the day of an event (check-in, sign-up, food or t-shirt sales, etc.) Fundraising/Development Volunteer: Graphic or website design Photography/videography Marketing/Public relations Other: Landscaping/gardening Repairs/carpentry Electrical Plumbing Areas of Interest (Please select all that apply. To select more than one option, press the CTRL button.): * Grooming, tacking and leading a horseSidewalkingTack cleaningStall & paddock cleaningGeneral barn choresMailingsEvent preparation/clean-upBake/cookWork the day of an eventGraphic or website designPhotography/videographyMarketing/Public relationsLandscaping/gardeningRepairs/carpentryElectricalPlumbing Do you have any other special talent, skills, technical/professional experience or resources you'd be willing to share with Lovelane?: Volunteer CapabilitiesLovelane takes the safety of our students, staff and volunteers very seriously. Answering ‘No” to any of these questions does NOT necessarily disqualify you from volunteering in some capacity at Lovelane. These questions help us match your skills to our needs. Your answers will be kept confidential. 1. Some volunteer positions require you to lift 30 pounds as needed. Can you meet this requirement? : * YesNo 2. As a sidewalker/horse leader you will be required to walk in 30 minute increments for up to a four hours. This may include the ability to jog briefly alongside a trotting horse. Can you meet this requirement?: * YesNo 3. As a sidewalker you may be required to lift your arms above shoulder height to support the child during lessons. Can you meet this requirement?: * YesNo 4. Are you able to understand and execute directions given by an instructor during the session?: * YesNo 5. Do you have any condition or take any medication that can affect your physical coordination/stability or can cause you to unexpectedly lose consciousness?: * NoYesPARENT/GUARDIAN INFORMATION (for volunteers UNDER 21)PARENT/GUARDIAN #1 Salutation: First Name: Last Name: Relation to child: Email (one email address per family is required) : Home Phone: Mobile Phone: Work Phone: Preferred Method of Contact (please choose one): EmailMobile PhoneHome PhoneWork Phone Occupation/Title: Employer: Address (if different from Volunteer): City: State: Zip: PARENT/GUARDIAN #2 Salutation: First Name: Last Name: Relation to child : Email (please leave blank if parent does not have email address): Home Phone: Mobile Phone: Work Phone: Preferred Method of Contact (please choose one): EmailMobile PhoneHome PhoneWork Phone Occupation/Title: Employer: Address (if different from Volunteer): City: State: Zip: EMERGENCY CONTACT(for volunteers OVER 21) Name (First and Last): Relation to volunteer: Phone: RELEASE FORMS (for volunteers UNDER 18, a parent/guardian must fill out this section)TRAIL RIDING RELEASE In addition to riding lessons conducted within the indoor and outdoor arenas, and horsemanship lessons taught at various locations, Lovelane periodically takes students for mounted trail rides on the properties located near the Property (the “Trails”). The Trails are not maintained by Lovelane and Lovelane does not have control over their condition. Lovelane has not undertaken to inspect the Trails for hazards which may exist on the Trails. In addition, the Horses may behave differently when being ridden on the Trails, such as being more prone to tripping or spooking. The Participant’s Parents may elect to allow the Participant to ride on the Trails or may withhold such consent. The granting or withholding of consent will not otherwise affect the Participant’s participation in the program and is completely voluntary. If the Participant’s Parents elect to permit the Participant to ride on the trails, the Participant and the Participant’s Parents specifically agree to hold Lovelane and Landlord harmless from any injury or death arising from the conditions of the Trails. If UNDER 18 years old, a parent/guardian must make the selection: * ConsentNon ConsentRELEASE FOR USE OF PHOTOS AND LIKENESS I hereby knowingly and voluntarily consent to the use and publication, without prior notice or compensation, of my name, likeness, voice, and/or participation, whether or not edited, retouched, or otherwise modified, by Lovelane Special Needs Horseback Riding Program, Inc. (“Lovelane”), its employees, officers, directors, agents, and any other person or entity acting on Lovelane’s behalf, for any and all purposes including, but not limited to, educational, promotional, advertising, informational, fundraising and commercial purposes, through any medium or format, including, but not limited to, photograph, videotape, audiotape, film, television, radio, internet, digital, printed material or presentation, at any time from this date forward. I further waive any claims against Lovelane, its employees, officers, directors, agents, and any other person or entity acting on Lovelane’s behalf, based upon or related to the use or publication of my name, likeness, voice, and/or participation. I have read and understood the terms of this release and hereby acknowledge that I am providing this release knowingly and voluntarily. I further acknowledge that I have been given sufficient consideration for this release. I understand that I may only revoke this release by giving written notice to the individual listed below. If UNDER 18 years old, a parent/guardian must make the selection: * ConsentNon-ConsentLOVELANE SPECIAL NEEDS HORSEBACK RIDING PROGRAM, INC. RELEASE AND INDEMNIFICATION This release and indemnification is made by and between the undersigned participant (the “Participant” including but not limited to students, compensated and non-compensated employees), the undersigned Participant’s parents (the “Participant’s Parents”) and any and all persons and parties now or hereafter having any interest in the charitable organization known as Lovelane Special Needs Horseback Riding Program, Inc., a Massachusetts corporation, together with any and all employees, agents and servants of Lovelane Special Needs Horseback Riding Program, Inc.; any and all sponsors, judges, volunteers, interns, coordinators, officials, benefactors and any other individual or entity having any connection with or relation to Lovelane Special Needs Horseback Riding Program, Inc. (collectively, “Lovelane”). Lovelane provides horseback riding lessons, outdoor activities and volunteer opportunities related to horsemanship and the care and upkeep of horses, other animals and farms to individuals, including but not limited to children with physical, emotional and mental challenges (the “Program”). Lovelane owns, leases, and/or utilizes stable, pasture, indoor and outdoor arenas and related spaces at the properties known as and located at 40 Baker Bridge Road in Lincoln Massachusetts, 9 Cambridge Turnpike in Lincoln Massachusetts and 21 Plain Road in Weston Massachusetts (collectively, the “Farm”; the owners, from time to time, of the properties comprising the Farm are referred to herein collectively as the “Landlord”). Lovelane owns, leases, cares for and/or maintains certain horses used or to be used in connection with the Program (the “Horses”). As used herein, the word “horse” shall include horses and ponies of every kind. The Participant wishes to participate in the Program and ride and work with the Horses at the Farm and/or at such other places as Lovelane conducts its activities, including but not limited to horse shows, clinics, fairs, expositions, schooling sessions and the like conducted away from the Farm. The Participant and the Participant’s Parents desire that the Participant have the opportunity to participate in the Program and ride and work with the Horses at the Farm and/or at such other locations as Lovelane conducts its activities. Lovelane will not permit the Participant to participate in the Program or work with or ride the Horses without the execution of this release and indemnification which is of material significance to Lovelane The Participant and the Participant’s Parents hereby acknowledge and agree that the activities contemplated hereby are “equine activities,” that Lovelane and the Landlord are each an “equine professional” and/or an “equine activity sponsor,” and the Participant is a “participant” all as defined by Massachusetts General Laws Chapter 128, Section 2D. Now therefore, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Participant and Participant’s Parents agree as follows: Inherent Risks. The Participant and Participant’s Parents acknowledge and understand that horses and activities related to horses are inherently dangerous and that there are dangers and risks which are an integral part of equine activities. Despite these inherent risks, the Participant has chosen, and Participant’s Parents have chosen to allow the Participant, to ride and/or work with and around the Horses (the “Activities”). Participant’s Representations. The Participant and the Participant’s Parents have been provided with medical and informational intake forms by Lovelane. The Participant and the Participant’s Parents hereby certify that the information contained therein is true and accurate in all respects. Participant and Participant’s Parents hereby acknowledge that Lovelane will and may rely on the information disclosed thereby without further inquiry or investigation. If, at any time, the medical, physical, emotional or mental condition of the Participant shall change in any material respect or if any of the information required to be disclosed by such forms shall change in any respect, Participant and Participant’s Parents shall immediately notify Lovelane in writing. In no event shall Lovelane be responsible for inquiring into the condition of the Participant’s physical, medical, emotional or mental condition or any change in such condition. The Participant represents, warrants, covenants and agrees that he or she will not ride or otherwise use any horse, whether owned by Lovelane, the Participant or another, in any activity or for any purpose if the Participant is unable to safely manage, control and ride such Horse. If, at any time, the Participant or Participant’s Parents believe that the Participant is unable to safely manage the Horse, he or she shall immediately dismount the Horse and notify Lovelane. Equipment. The Participant and Participant’s Parents acknowledge and understand that the equipment used in connection with the Activities, including but not limited to saddles, bridles, bits, brushes, pitchforks, shovels, brushes, combs and hoof picks are each given to wear and tear. The Participant and Participant’s Parents agree to use the utmost care at all times while at the Property and to inspect all equipment carefully for evidence of defects or breakage. In the event that the Participant or Participant’s Parents locate any defects or breakage in any equipment owned or utilized by Lovelane, he or she shall immediately notify Lovelane. In no event shall Lovelane be held liable for any injury to or death of the Participant caused by any defect in any equipment, whether or not such equipment is owned, utilized and/or provided by Lovelane. Helmets. The Participant and Participant’s Parents hereby acknowledge that they have been warned of the dangers involved in failing to wear protective headgear and that Lovelane REQUIRES that all individuals who are able to do so wear ASTM-SEI approved protective headgear, with chin strap securely fastened, at all times while working with or riding any Horse on the Property. Certain children may not be able to wear an ASTM-SEI approved helmet due to physical limitations. In such cases, pursuant to the guidelines of Professional Association of Therapeutic Horsemanship International (PATH Intl.), the child may wear an alternative helmet. The Participant and the Participant’s Parents acknowledge that there are additional risks posed by riding a horse without a helmet approved for horseback riding and specifically agree to indemnify, defend with counsel acceptable to Lovelane and hold Lovelane harmless for any injury or damage resulting, directly or indirectly, from the failure of Participant to wear an approved helmet.Release. The Participant and Participant’s Parents agree that they shall not hold Lovelane or Landlord liable for any injury to or the death of the Participant or Participant’s Parents resulting from or related to his or her involvement in equine activities and/or the Activities. The Participant and Participant’s Parents hereby remise, release and forever discharge Lovelane and Landlord for him or herself and his or her heirs, executors and administrators, of and from all manner of actions, cause or causes of actions, suits, reckonings, controversies, damages, claims and demands, in law or at equity, that he or she now has or hereafter can or may have or which his or her heirs, executors or administrators hereafter can, shall or may have by reason of any injury to or death of the Participant or the Participant’s Parents caused by or in any manner related to equine activities and/or the Activities. Indemnification. The Participant and Participant’s Parents further indemnify, agree to defend with counsel acceptable to Lovelane and hold Lovelane and Landlord harmless for any injury or damage caused, directly or indirectly, by the Participant or Participant’s Parents to any person or the property of any person (including, without limitation, damage to Lovelane, Lovelane’s property, the Property and/or any of the Horses), which injury or damage is caused, directly or indirectly, in whole or in part, by the Participant or Participant’s Parents. The Participant’s Parents hereby acknowledge and agree if the Participant does not have sufficient funds to fully indemnify Lovelane an Landlord, they shall be personally and jointly and severally liable to Lovelane for any such injury or damage. Consent to Emergency Medical Care. In the case of any injury or apparent injury to the Participant while at the Property and/or riding the Horses, the Participant and Participant’s Parents hereby authorize Lovelane and any agent or employee of Lovelane, to seek medical care and attention for the Participant, including but not limited to arranging for an ambulance to take the Participant to any medical care facility, transporting the Participant to any medical care facility and consenting to treatment, medication and/or surgery for the Participant. The Participant and Participant’s Parents acknowledge that they shall be solely responsible for the payment of any medical costs and expenses incurred on behalf of the Participant and hereby indemnify and agree to hold harmless Lovelane for any costs incurred by Lovelane on behalf of the Participant. Parental Consent and Waiver of Consortium Claims. The Participant’s Parents hereby warrant and represent that they are the parents and lawful guardians of the Participant. The Participant’s Parents, by their execution hereof, hereby agree and assent to the terms of this Agreement and execute this contract on behalf of their minor child, the Participant, intending it to be legally binding and fully enforceable against the Participant and themselves. The Participant’s Parents, by the execution hereof, further remise, release and forever discharge for themselves and their heirs, executors and administrators, Lovelane and Landlord of and from all manner of actions, cause or causes of actions, suits, reckonings, controversies, damages, claims and demands, in law or at equity, that they now have or hereafter can or may have or which their heirs, executors or administrators hereafter can, shall or may have by reason of any injury to or the death of the Participant, including but not limited to actions for loss of consortium. Massachusetts Contract. This Agreement is a Massachusetts contract and shall be interpreted and construed in accordance with the laws of The Commonwealth of Massachusetts, without regard to conflicts of laws principles. The Participant and Participant’s Parents hereby state under the pains and penalties of perjury that they have read this Release and Indemnification in complete detail, that they understand the consequences of executing this Release and Indemnification and that they execute this Release and Indemnification as an instrument under seal, as of the date listed below. This Release and Indemnification shall be binding upon the Participant and Participant’s Parents each and every time the Participant rides or works with the Horses, without the need for re-execution, unless and until revoked in writing by the Participant and the Participant’s Parents. Warning Under Massachusetts law, an equine professional is not liable for an injury to, or the death of, a Participant in equine activities resulting from the inherent risks of equine activities, pursuant to section 2d of chapter 128 of the general laws. The Undersigned has read and voluntarily signs the Release and Waiver of Liability and Indemnity Agreement and further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made. By entering my name below, I am effectively providing my signature, indicating that all the information on this form is true and accurate to the best of my knowledge. Assumption of Risk and Waiver of Liability for Volunteers & Staff Relating to COVID-19 with Guidelines (Effective 7/26/2020) This waiver will be valid until January 31, 2021, unless notified by Lovelane Special Needs Horseback Riding Program Inc. This waiver must be completed for all volunteers and staff members coming to Lovelane Special Needs Horseback Riding Program Inc., located at 40 Baker Bridge Road, Lincoln, MA 01773, prior to entering the facility. The novel coronavirus, COVID-19 is an extremely contagious world-wide pandemic that can cause serious and potentially life-threatening illness and even death. Lovelane has put in place preventive measures to reduce the spread of COVID-19, and will be following all the guidelines provided by the Department of Public Health, however, Lovelane Special Needs Horseback Riding Program cannot guarantee that you will not become infected with COVID-19. With the understanding that leaving your home and going anywhere increases your risk of contracting COVID-19, you acknowledge the contagious nature and voluntarily assume the risk of exposure. All guidelines which were emailed to you must be abided by with special attention to the following: Lovelane will require self-administered temperature checks for everyone coming to Lovelane (staff, volunteers, riders and their caretakers) immediately before coming to Lovelane. Anyone with a fever of 100.4 or above should not come to Lovelane. Everyone visiting Lovelane over the age of two, who can, is required to wear a maskor face covering while at Lovelane. All persons will wash their hands or use sanitizer upon entering the facility. Handwashing is your best self-defense against the spread of germs. As a backup, we have additional alcohol based hand sanitizer readily available to you around our facility. Everyone must commit to social distancing, as much as possible, while they are at Lovelane and outside of Lovelane. Anyone who is ill, or has been exposed to someone who is ill, should not come to Lovelane. Expanded Sick Policy All students, volunteers and Lovelane employees must stay home if they, or any member of their household, or anyone they have been in contact with shows any symptoms, including, but not limited to: - Fever (temperature of 100.4°F or above), felt feverish, or had chills - Gastrointestinal symptoms (diarrhea, nausea, vomiting) - New loss of smell/taste - Sore throat - Headache - Difficulty breathing - Cough - New muscle aches - Any other signs of illness Any student, volunteer or staff member who is ill or shows symptoms of being ill will be sent home. I hereby release, covenant not to sue, discharge, or hold harmless Lovelane Special Needs Horseback Riding Program, its employees, agents or representatives of and from any claims, including all liabilities, actions, damages, costs, or expenses of any kind arising out of, or relating to, whether a COVID-19 infection occurs before, during, or after visiting Lovelane Special Needs Horseback Riding Program. By entering my name below, I am effectively providing my signature indicating that all the information on this form is true and accurate to the best of my knowledge. By signing this waiver, I (or a parent/guardian, if volunteer or staff person is a minor) acknowledge that I have read and fully understand the content of this waiver and freely enter into it. Please sign by typing name below (If UNDER 18 years, a parent/guardian must enter their name): * Date for Release Forms (please use format: mm/dd/yyyy): * Send me a copy * These fields are required.