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Eos Therapeutic Riding Center

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Annual Volunteer Registration

This form is required annually for all volunteers, including new and returning volunteers.

Please plan to complete the form in one sitting and have required clearance documents available to upload.

As of July 1, 2015, all volunteers 18 & over must provide a copy of the following clearances to Eos BEFORE volunteering.

PA State Police Criminal Record Check
https://epatch.pa.gov/home
PA Child Abuse History Clearance
https://www.compass.dhs.pa.gov/cwis
FBI Fingerprint Background Check of FBI Disclosure Statement
https://www.pa.gov/agencies/dhs/resources/keep-kids-safe/child-abuse-clearances/fbi-fingerprinting
(Volunteer Service Code: 1KG6ZJ)
OR
FBI Disclosure Statement

Annual Volunteer Registration & Release

Volunteers 18 & older are required by Pennsylvania Law to have current clearances on file.

Volunteer*

New Volunteer

Returning Volunteer

First name*

Last name*

Birthday*

Month

Day

Year

Phone*

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

United States Veteran*

Yes

No

Are you 18 years of age or older?*

Yes

No

Are you currently a college or university student?*

Yes

No

I am interested in helping in the following area(s):

(Check all that apply)

I am interested i helping in the following area(s): (Check all that apply)

Horse leading

Side walking with a rider

Ground chores

Volunteer recruitment

Fundraising

Play with children when they are not riding

Writing for the Friends of Eos Newsletter

Public Relations

In case of emergency contact:

Name (First & Last)*

Relationship*

Home Phone

Work Phone*

Cell Phone*

Address*

Physician*

Physician Phone*

Do you have any pre-existing medical conditions which would prevent you from performing the duties of this volunteer role?*

Yes

No

I understand that, as outlined in the Volunteer Training Manual, volunteers are required to wear closed-toe shoes and appropriate attire at all times while volunteering or while in the arena or barn areas for safety.

Liability Release

As a volunteer at Eos Therapeutic Riding Center, I acknowledge the risks and potential for risks of a horseback riding program. However, I feel that the possible benefits to me and the riders I work with are greater than the risks assumed. I hearby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Eos Therapeutic Riding Center, its Board of Directors, instructors, therapists, aides, volunteers and/or employees for any and all injuries and/or losses that (I/my child/my ward) may sustain while participating in the therapeutic riding program.

Warning:You assume the risk of equine activities pursuant to Pennsylvania Law.

Date picker*

Volunteer Signature*

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Photo Release (optional)

I hearby consent to and authorize the use and reproduction by Eos Therapeutic Riding Center of any and all photographs and any other audiovisual materials taken of (me/my child/my ward) for promotional printed material, educational activities or for any other use of the benefit of the program.

Photo Release Consent*

Yes, I consent.

No, I do not consent.

A Non-Profit Corporation Providing Therapeutic Horseback Riding to Children and Adults with Special Needs and Veterans

Copyright 2022 Eostrc

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Address

288 Dahl Road,
Bloomsburg,

PA 17815-9776

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