Reins of Rhythm Volunteer/ Staff Form & Health History

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General Information

Name *

Date *

YYYY

Birthdate *

YYYY

Phone Number *

Cell Phone Number

Address *

Email *

Employer/School

Parent/Legal Guardian's Name (if under 18)

Parent/Legal Guardian Cell Number

Parent/Legal Guardian Address

Why are you interested in volunteering with Reins of Rhythm Riding & Horsemanship? *

Describe any previous horse experience you may have. *

Date of last Tetanus Shot *

YYYY

Tuberculosis Test : *

Please indicate if test was positive or negative, and provide date of test.

Health History: Describe your current health status , especially regarding the physical and emotional demands required to work in an equine assisted program. Please address fitness, cardiac, respiratory, bone or joint function, recent hospitalizations or surgeries, or lifestyle changes: *

Allergies:

Medications

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