Reining Strength Volunteer & Staff
Information Form & Health History 

Contact Information
Background Information

I authorize Reining Strength Therapeutic Horsemanship to receive information from any law enforcement agency, including police departments and sheriff’s departments, of this state or any other state or federal government, to the extent permitted by state and federal law, pertaining to any convictions I may have had for violations of state or federal criminal laws, including but not limited to convictions for crimes committed upon children or animals.

I understand that such access is for the purpose of considering my application as an employee/volunteer, and I expressly DO NOT authorize Reining Strength, its directors, officers, employees or other volunteers to disseminate this information in any way to any other individual, group, agency, organization or corporation.

The Volunteer Coordinator will contact you to obtain your Social Security Number for the background check. For your privacy your SSN will be used only to complete the background check and will be destroyed afterwards.


Authorization for Emergency Medical Treatment
Emergency Contact Information
Medical Treatment Consent

In the event that emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on Reining Strength Therapeutic Horsemanship property, I authorize Reining Strength Therapeutic Horsemanship, to:

1.        Secure and retain medical treatment and transportation if needed.

2.        Release client/participant’s records upon request to the authorized individual or agency involved in the medical emergency treatment.

This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed “life-saving” by the physicians. This provision will only be invoked if none of the Emergency Contacts listed above can be reached.

Orientation and Confidentiality

I will attend an orientation at Reining Strength Therapeutic Horsemanship (RSTH) and have an understanding of the information provided, will demonstrate the procedures pertaining to volunteering, and have received and read or will read a copy of the RSTH volunteer manual. I also have been made aware of RSTH’s confidentiality policy and understand that the any information that I have become privy to about a client during my time as a volunteer shall remain confidential. The consequences of violating RSTH’s confidentiality and privacy policy may include removal from the program. 

Photo Release
The use and reproduction by Reining Strength Therapeutic Horsemanship of any and all photographs and any other audio/visual materials taken of me or my family member for promotional material, educational activities, exhibitions, or for any other use for the benefit of the program or PATH Int’l. 
Liability Release
the undersigned adult as client, or parent or guardian of 
, a minor, would like to participate at Reining Strength Therapeutic Horsemanship. 
I acknowledge the risks and potential for risks of equine activities.  I understand that I/my son/daughter/ward, will be working with and around horses, as well as, riding horses at Reining Strength Therapeutic Horsemanship.  However, I feel that the possible benefits to myself/son/daughter/ward are greater than the risk assumed.  I, the undersigned client and/or parent or guardian, hereby, intending to be legally bound, for myself, my heirs, and assigns, executors or administrator, waive and forever release, acquit, discharge and hold harmless all claims for damages against Reining Strength, its board of directors, trustees agents, instructors, therapists, employees, representatives, volunteers, owners of property on which Reining Strength Therapeutic Horsemanship operates, successors or assigns on account of any personal injuries and/or personal damages known or unknown, or in any way growing out of, the acts of Reining Strength Therapeutic Horsemanship, its board of directors, trustees, agents, instructors, therapists, employees, representatives, volunteers, owners of the property on which Reining Strength Therapeutic Horsemanship operates, successors or assigns.