Volunteer Application Form

Please complete this application form if you are interested in becoming a Envision Therapeutic Horsemanship volunteer. Once you complete the form, click the Continue button at the bottom.

Please list in a cover letter to envisionvoice2020@gmail.com if you have experience with trauma informed care, social services, or if you have any experience working with at risk and/or traumatized youth or individuals while handling horses.

Name and address

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

OK to call me here

Work phone:

OK to call me here

Email address:

Demographic Information

Please provide the following information. The information will be used to screen applicants and run a background check.

Date of birth:

Age:

Gender:

Education:

Availability

Please indicate the days and times you are usually available to volunteer.

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.

Emergency Contact

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2

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Email address:

Relationship:

Relatives

Employer

Employer name:

Title:

Work phone:

Email address:

References

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2

First name:

Last name:

Title:

City:

State:

Work phone:

Email address:

Confidentiality

Clients need to be able to trust that staff and volunteers will protect information shared in confidence. They should feel free to fully disclose sensitive personal information to enable staff and volunteers to most effectively provide needed services. Staff and volunteers in turn have an ethical obligation to preserve the confidentiality of information gathered in association with the care of the client.

In general, clients are entitled to decide whether and to whom their personal health information is disclosed. If a situation of self harm arises, please talk to staff immediately about your concerns.

I agree to keep clients information safe and confident. I agree to discuss clients only with Envision Staff.

I Agree