Volunteer Application | New Canaan Mounted Troop

Super Troopers Volunteer Application & Information

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New Canaan Mounted Troop – Super Troopers Volunteer Application & Information

Today's Date

Date of Birth

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Home Phone*

Cell Phone*

Preferred Phone*

May we text you for scheduling purposes?*

Yes

Employer / School*

Occupation

Parent/Guardian Name (if under 18)

First Last

Parent/Guardian Email

Parent/Guardian Phone

Please note that NCMT Super Troopers Program as of 9/2024 will be implementing background checks for those 18 and older. NCMT will not accept applicants into our volunteer program who have been arrested for or convicted of crimes, including but not limited to those against persons and/or animals, arson, theft, firearms possession, narcotics possession.

Medical & Emergency Contact Information

In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services, or while being on the property of the agency, I authorize NCMT to: 1. Secure and retain medical treatment and transportation if needed. 2. Release client records upon request to the authorized individual or agency involved in the medical emergency treatment.

Name:*

First Last

Physician's Name:*

First Last

Physician's Phone*

Preferred Medical Facility:*

Allergies:*

Current Medications:*

Health Insurance Provider*

Health Insurance Policy No.*

Please note any conditions we should be aware of in the event of an emergency:*

In the event of an emergency Contact:*

First Last

Relationship:

Phone

In the event of an emergency Contact:*

First Last

Relationship:

Phone

Medical Treatment Consent Signature*

I AUTHORIZE THE STAFF OF NEW CANAAN MOUNTED TROOP, INC., TO SIGN FOR THE ADMITTANCE AND TREATMENT OF THE PERSON(S) INCLUDED IN THIS REGISTRATION AT AN EMERGENCY MEDICAL TREATMENT FACILITY, IN THE EVENT THE PARENT/GUARDIAN IS NOT AVAILABLE. ALL INFORMATION SUBMITTED WILL BE HELD STRICTLY CONFIDENTIAL. IF THERE IS A CHANGE IN THE ABOVE INFORMATION, I WILL NOTIFY NCMT IMMEDIATELY.

Printed Name (for Medical Consent)*

Warning, Indemnity, Hold Harmless and Release of Liability

All volunteers must agree to the following terms.

WARNING

Pursuant to Connecticut General Statutes §52-557p, a person engaged in recreational activities assumes the risk and responsibility for any injury to his or her person or property arising out of the hazards inherent in equestrian sports, unless the injury was caused by the negligence of the person providing the horse/pony or horses/ponies to the individual engaged in the equestrian activities, or the failure to guard or warn against a dangerous condition, use, structure or activity of the person providing the horse/pony and/or horses/ponies, or his or her agents and or employees.

ACKNOWLEDGEMENT

I, and/or on behalf of my child listed below, understand that there is an inherent risk in equestrian sports, including but not limited to the risk of serious physical injury, loss and/or death. However, I feel that the possible benefits for myself /my child /my ward are greater than the risk assumed. I, on behalf of myself /my child /my ward, fully assume all risks associated with equestrian sports, including Therapeutic Riding Programs, even if due to the NEGLIGENCE of New Canaan Mounted Troop, Inc. (hereinafter referred to as “NCMT”), and any of its instructors, Therapeutic Riding instructors, or guest instructors invited by NCMT, its Officers, Directors, Agents, Volunteers and/or Employees, including but not limited to variations in the indoor and outdoor ring conditions; man-made obstacles; collisions with object either inside or outside the riding rings including but not limited to jumps, hay bales, shrubbery, rocks, equipment, employees, participants, or other patrons and spectators on the property; lack of safety devices, or inadequate safety devices; lack of warning or inadequate warning; lack of instruction or inadequate instruction. I, on behalf of myself / my child / my ward, am responsible for immediately informing NCMT of any mental, physical or other condition, or change in condition, that may affect my child’s ability to participate in equestrian sports, including Therapeutic Riding Programs.

HORSES & PONIES

I, or on behalf of my child listed below, understand that horses and ponies, although tamed, trained and boarded at NCMT are in fact a “wild” animal, and may buck, shy, spook, kick, bite and/or react unexpectedly to the actions of other horses or ponies, riders, employees of NCMT, and environmental effects including but not limited to noise, wind, light/darkness, or any man-made or environmental anomaly beyond the control of NCMT, its instructors, guest instructors, Officers, Directors, Agents, Volunteers and or Employees.

INDEMNIFICATION

I, or on behalf of my child listed below, for myself and for my heirs, assigns, successors, executors, administrators and legal representatives, agree that I will defend, indemnify and hold harmless, NCMT and any of its instructors, Therapeutic Riding instructors, or guest instructors invited by NCMT, its Officers, Directors, Agents, Volunteers and/or Employees, free from any and all claims, suits or demands by anyone arising from my use of the facility, equipment and/or horses/ponies owned by, boarded at NCMT, or brought onto the property owned by NCMT, including claims of NEGLIGENCE on the part of NCMT and any of its instructors, Therapeutic Riding instructors, or guest instructors invited by NCMT, its Officers, Directors, Agents, Volunteers and/or Employees.

RELEASE

I, or on behalf of my child listed below, for myself and for my heirs, assigns, successors, executors, administrators and legal representatives, hereby release and agree that I will not sue NCMT and any of its Instructors and Employees, its Therapeutic Riding Instructors, or guest instructors, its Officers, its Directors, its Agents, its Volunteers, and/or other guests invited by NCMT, for money damages and/or for any injury, loss and/or death, emotional distress, or from theft to person, horse/pony or possession, sustained by me while using the facility, equipment and/or horses/ponies owned by, boarded at NCMT, or brought onto the property owned by NCMT, even if due to the NEGLIGENCE of NCMT and any of its instructors, Employees, its Officers, Directors, Agents, Volunteers, Therapeutic Riding Instructors, or guest instructors or other guests invited by NCMT. This hold harmless agreement shall extend to all activities engaged in including but not limited to horseback riding activities and any exposure or resulting illness or death from any communicable disease, including Covid-19 or biological agent.

Name (for Waiver)*

First Last

Waiver Signature*

WARNING, INDEMNITY, HOLD HARMLESS & RELEASE OF LIABILITY
I have read this WARNING, INDEMNITITY, HOLD HARMLESS and RELEASE OF LIABILITY and fully understand its terms. I further understand that by signing this agreement that I may be waiving specific legal rights, either for myself or for my undersigned child on whose behalf I am signing this agreement. I have not been induced to sign this agreement and have not signed pursuant to any promise or representation which has not been attached hereto, if any. I sign said agreement voluntarily and of my own free will.

Photo/Media Release

Photo/Media Release: Approve/Decline*

Do you consent to the following?

I grant to New Canaan Mounted Troop, Inc., (“NCMT”) its representatives and employees the right to take photographs or videos of my child/children or myself (“my family”) in connection with my family’s activities associated with NCMT. I authorize NCMT, its assigns and transferees to copyright, use and publish the same in print and/or electronically as part of its advertising, publicity, fundraising efforts or other uses. I understand that NCMT will not compensate my family for such use and hereby waive any right to inspect and approve the use to which it may be applied.

Approve

Decline

Notes/Comments on Photo/Media Release

Photo/Media Release Signature*

Printed Name of Photo/Media Release Signer*

"I certify that all the information provided on this form is true, accurate, and up to date, and guarantee to alert NCMT Super Troopers staff to any changes."

All Volunteers Will:

Call office (203-966-0634) or text Felicia (713-819-7443) when unable to attend at regularly scheduled day and time – especially if your situation changes at the last minute
Arrive 10 minutes before the start of class
Wear appropriate clothing and shoes. Shoes should be comfortable yet offer protection – no open toes. Avoid loose or floppy items, long earrings and necklaces. Refrain from using perfume or cologne which can attract bees and/or insects
Walk when on the premises (exception: emergencies)
Use appropriate voices and avoid sudden movements, particularly near the horses
Not chew gum or eat while in program
Not use cell phone when in program for calls or texting (exception: emergencies.)
Ask permission before taking any photographs or video, especially with lights or a flash
Not feed any animals unless instructed by NCMT personnel
Absolutely not smoke anywhere on the premises
Refrain from use of drugs or alcohol prior to and during program activities
Will not bring dogs or pets on the premises at any time. Exceptions will be made for service dogs
Prior to the mounted and/or unmounted activities, inform the instructor of any changes in your medical condition that may impact your ability as a volunteer in program
Inform the instructor and/or volunteer coordinator of any schedule changes or conflicts which would affect your attendance
Follow NCMT/Super Troopers confidentiality agreement

Failure to follow the established safety procedures, demonstration of inappropriate and/or abusive behavior towards others, incidents due to the use of drugs or alcohol, and demonstration of mistreatment/abuse of equines and/or other animals on the site may result in immediate dismissal from the Super Troopers Program. I have read and agree to adhere to the basic rules and procedures outlined above.