Hunkapi Programs Volunteer Application

Please complete this application form FULLY if you are interested in becoming a Hunkapi Programs, Inc. volunteer. Once you complete the form, click the Continue button at the bottom. We will be in touch to schedule a Level 1 Orientation. If this form is being completed for someone under the age of 18, a parent or guardian must complete and approve to all information indicated in this form.

If you are 13 or under, you must volunteer with an adult. Please make sure an adult completes another application to volunteer with you.

General Information

First name:

Last name:

Street 1:

City:

State:

* Zip: *

Home phone:

OK to call me here

Cell phone:

* OK to call me here

Email address:

How did you hear about us?:

Your Occupation:

Social Security Number:

Employer name:

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us. We primarily use email to communicate and opting out will leave you uninformed.

Demographic Information

Please complete the following information. For 1 & 2, please provide 2 emergency contacts.

Date of birth:

Age:

Gender:

Education:

T-Shirt size:

Do you speak a second language?:

Do you know ASL?:

Does your employer offer matching gifts:

School/Education:

Your Hobbies/Interests:

1

2

First name:

Last name:

Cell phone:

* OK to call here

Cell phone:

* OK to call here

Relationship:

Availability

Please indicate the days and times you are usually available to volunteer. These do not need to be exact.

Skills and Talents

Please list and describe any background or skills you may have in Design and Marketing, Finance, Education, Social Media and Computers, or Others. Please write N/A if not applicable:

Health

Do you have any physical or emotional health concerns that may affect your ability to work safely around horses and/or clients? (This includes overall fitness, cardiac health, respiratory health, bone or joint function, hospitalizations/surgeries and any lifestyle changes that may affect your emotional/mental health state while volunteering at Hunkapi.) If yes, please explain.

Physical Activity

Please use the space to answer the following questions:

1. Are you able to walk at a brisk pace for at least 30 minutes (Yes/No)?

2. Are you able to carry and/or support at least 50 pounds (Yes/No)?

3. Are you able to jog for a short distance (Yes/No)?

Please indicate YES or NO for each question.

Medical Information

Please list any allergies, medications, or medical conditions or write N/A if not applicable.

Physician Information

Please list your physicians name, physician's phone number, insurance company, and insurance account number.

Medical Consent for Treatment

1. Consent for treatment: In the event that emergency medical aid/treatment is required for me (or my child/ward)

due to illness or injury while on Hunkapi Programs Inc.’s property or participating in any Hunkapi Programs Inc. related

activity, I authorize Hunkapi Programs Inc. to secure and obtain medical treatment and/or transportation, if needed. This

includes, but is not limited to, x-rays, surgery, anesthesia, hospitalization, medication and any treatment/procedure

deemed “lifesaving” by a physician, hospital or other medical facility. This provision will only be invoked if I (or my

child/ward) am unable to communicate or arrange for treatment, and my parent/guardian or emergency contacts listed

above cannot be reached in a timely manner and Hunkapi Programs Inc. must act on my behalf. I understand that the

cost of any such treatment authorized by Hunkapi Programs Inc. shall remain my responsibility.

2. Decline consent for treatment: I DO NOT give consent for Hunkapi Programs Inc. personnel to authorize medical

treatment for me (or my child/ward), except to arrange for emergency medical treatment/aid on my behalf. In the event of

an emergency, I wish the following to take place.

Please indicate either "Consent for Treatment" or "Decline consent for treatment" with details or what you wish to take place.

Photo/Video Release

I understand that I consent to and authorize the use and reproduction of any photographs and/or any other audiovisual materials taken or me, my child, my ward, for promotional materials, educational activities, social media and exhibitions for any use for the benefit of Hunkapi Programs.

YES or NO?

Helmet Policy

I understand and agree that Hunkapi Programs Inc. requires all riders 17 years and younger to wear the SEI Certified ASTM Standard F 1163 Equestrian Helmet, unless their parents or legal guardians sign a refusal statement in the box that follows. Please write Accept or Decline:

1. Acceptance: I/We request for me/my child/ward to wear protective headgear/helmet provided by Hunkapi Programs Inc. 2. Decline: I/We decline for me/my child/ward to wear any type of protective headgear/helmet provided by Hunkapi Programs Inc., and/or will provide my/our own protective headgear.

Release of Liability

By clicking "I agree," you certify that you agree to the following:

1. I agree to indemnify and hold harmless Hunkapi Programs Inc., and its members, officers, servants, agents, volunteers and employees (hereinafter Hunkapi Programs Inc.), for any costs incurred to treat me, even if Hunkapi Programs Inc. has signed medical facility documentation promising to pay for the treatment due to my inability to sign the documentation. I further agree to release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes. Hunkapi Programs Inc. from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorneys’ fees and expenses, that may be sustained by me while receiving medical care or in Hunkapi Programs Inc. deciding to seek medical care, including while traveling to and from a medical care facility, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of Hunkapi Programs Inc. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct.

2. I understand that participation at Hunkapi Programs Inc. is voluntary. I give permission for my child/my ward to participate in horseback riding and/or volunteer in program activities operated by Hunkapi Programs Inc.

3. I represent that I am physically able to undertake all reasonable volunteer activities and I/my child/my ward participates in such activities at our own risk.

4. I understand a horse may, without warning or any apparent cause, buck, stumble, fall, rear, bite, kick, run, make unpredictable movements, spook, jump obstacles, step on a person's feet, push or shove a person. I understand that saddles or bridles may loosen or break, all of which may result in serious injury or death to anyone working with or around horses.

5. I understand that under Arizona State Law, an equine owner or agent is not liable for any injury to or the death of a participant in equine activities resulting from the inherent risk of equine activities pursuant to Arizona Revised Statutes 12-553.

6. I agree to assume all risks that may result in injury to me/my child/my ward or any other person while volunteering, participating, or observing Hunkapi Programs Inc. activities. I understand that unexpected events may occur while I/my child/my ward is volunteering for, participating in, or observing these activities. It is my express consent that this entire agreement shall bind the members of my family, my spouse, my heirs, assigns and personal representatives.

7. I assume full responsibility and liability for the conduct and safety of any and all persons I bring onto the property where Hunkapi Programs Inc. events are conducted, including minors.

8. I agree that in consideration for allowing participation in horseback riding and/or other program activities operated by Hunkapi Programs Inc., I hereby release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes Hunkapi Programs Inc. and its members, officers, servants, agents, volunteers and employees, and the owners and operators of all facilities utilized by Hunkapi Programs Inc. in the provision of services and program activities (hereinafter Hunkapi Programs Inc.) from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, that may be sustained while participating in or observing such activities, while traveling to and from such activities, or while on the premises owned or leased by Hunkapi Programs Inc., including injuries sustained as a result of the sole, joint, or concurrent negligence per se, statutory fault, or grossly negligent conduct.

9. I agree that, for myself, my child and/or legal ward, that we have been fully warned and advised by Hunkapi Programs Inc. that protective headgear/helmet, which meets or exceeds the quality standards of the SEI Certified ASTM Standard F 1163 Equestrian Helmet, should be worn while riding, handling and/or being near horses. I understand that wearing of such headgear/helmet at these times may reduce severity of some of the wearer’s head injuries and possibly prevent the wearer’s death from happening as a result of a fall and other occurrences.

10. I acknowledge that Hunkapi Programs Inc. has offered me, and my child and/or legal ward if applicable, protective headgear/helmet that meets or exceeds the quality standards of the SEI Certified ASTM Standard F 1163 Equestrian Helmet.

11. I acknowledge that, once provided, if I choose to wear the protective headgear/helmet offered, I will be responsible for properly securing the headgear/helmet on my head or my child’s/ward’s head at all times.

12. I hereby authorize Verified First, on behalf of Hunkapi Programs Inc., to procure a local and/or national background check on me. I understand the background check will contain record of any criminal conviction and/ or criminal file maintained on me whether local, state, or national. I hereby release True Hire and Hunkapi Programs Inc. of any and all claims and liability resulting from such disclosures. I hereby authorize all law enforcement agencies to release all information they may have about me to Verified First and Hunkapi Programs Inc. or its agents, and do forever release them from any liability or responsibility for doing so to the fullest extent allowed by law from any claims from the requested information. I recognize and agree that a copy or facsimile of this document shall be as valid as the original. I recognize and agree that this release shall be valid for this and any future update reports requested. According to the Fair Credit Reporting Act, I am entitled to know if I am denied based on information contained in this report, and to receive, upon written request, a disclosure of the public record information as well as the nature and scope of the investigative report.

I have read and understand all the above and waive any claim which may arise against Hunkapi Programs Inc., its officers, instructors, volunteers, participants, employees, agents or owners of the property where Hunkapi Programs Inc. events are conducted. This agreement is effective upon signing and continues so long as I participate in Hunkapi Programs Inc. events.

I Agree

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