Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Can you receive text messages at this number? *

Yes

No

Date of Birth *

MM

DD

YYYY

Emergency contact phone number *

(###)

###

####

Please check all that apply to you:

I can maneuver over difficult or uneven terrain independently.

I am not afraid of horses.

I can lift up to 20 pounds.

I can work in the heat or cold for several hours (with breaks as often as needed).

I can push a full wheelbarrow short distances and up slight ramps.

I am willing to tend to superficial wounds on a horse.

I have medical insurance that covers my participation in volunteer activities.

Does your employer support community volunteerism by offering monetary grants to organizations where you volunteer?

Yes

No

I’m not sure but I will look into it!

NA

I understand that Groundwork Ranch may perform a background check on me and that I will be asked to cover the $20 cost of the background check. *

By checking this box, you agree to the statement above.

FINISH AND SUBMIT *

By checking this box, you affirm that the information you've provided in this application is true and accurate to the best of your knowledge.