CKRH Internship Application
Page 1
CKRH Mission Statement
Central Kentucky Riding for Hope is dedicated to enriching the community by improving the quality of life and the health of children and adults with special physical, cognitive, emotional and social needs through therapeutic activities with the horse.
General Information
Prefix
Please select...
Mr.
Mrs.
Ms.
First Name
Last Name
Birthdate
mm/dd/year
Employer
Address Information
Mailing Number/Name
Please spell out all parts of the address including the Street, Road, etc.
Mailing City
Mailing State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AS
DC
GU
MP
PR
PW
VI
Mailing Postal Code
Contact Information
Email
Alternate Email
Phone
Alternate Phone
Please indicate which internship you are applying for.
Please select...
Equine Care and Management Internship (Jan.-May, June-Aug., or Aug.-Dec.)
Barn Management and Programming Logistics Internship (Feb.-May, May-Aug., or Aug.-Dec.)
Paid: Development and Marketing Internship (Feb.-June)
Please indicate which time frame you are applying for
Please select...
Jan.-May
June-Aug.
Aug.-Dec.
Feb.-May
May-Aug.
Feb.-June
Page 2
First Name
Last Name
Gender
Male
Female
Volunteer Availability
Please describe your availability including days off.
Interests/Previous Experience
Previous Experience with Special Needs
Yes
No
Previous Horse Experience
Yes
No
Please list your reason for interning and/or pertaining experience?
How did you hear about CKRH?
Please upload your resume.
Please upload your cover letter.
Page 3
Intern's Authorization for Emergency Medical Treatment
First Name
Last Name
CKRH asks for medical information to ensure the safety of all of our interns. It is in your best interest to complete this section. However, if you do not fill out this section, CKRH will use their standard safety measures in the case of an emergency.
Medical Information
Hospital Preference
Physician's Name
Physician's Phone Number
Health Insurance Company
Policy #
Emergency Information
Emergency Contact
Emergency Contact Phone
Emergency Contact Phone
Able to walk for 45 minutes
Yes
No
Health Issues or Physical Limitations
Yes
No
Current Medications
Information for Emergency Responders/Please List Any Alergies
Contact Information