Today's Date:

Name:      Birth Date:

Address:     City:

State:      Zip Code:

Daytime Phone:

Evening Phone:

E-Mail:

Please check the locations that you are interested in volunteering:

Indiana Horse Rescue Central (Frankfort)
Indiana Horse Rescue Pike
Indiana Horse Rescue South (Cannelton)
Indiana Horse Rescue Southwest (Owensville)
Other:

Please fill in the blanks under the days you are available, with the times you will be available:

Other:

The following questions are for the safety of our staff and other volunteers, this information will remain confidential:

Have you ever been convicted of a felony?     Yes         No
If you selected Yes, please explain:

Have you ever been convicted of a sexual offense?     Yes         No
If you selected Yes, please explain:

Have you ever been convicted of animal cruelty or neglect?     Yes     No
If you selected Yes, please explain:

Please complete the following information about yourself and your experience with horses: (NOTE: If you have no experience with horses, that is just fine, we would just like to know if you do.)

How many years of experience do you have...

Please describe you hose experience, based on the years of experience that you have marked above:

Please describe any other experiences or talents that you would like us to know about:

Emergency Contact Name/Relation:
Home Phone:
Mobile Phone:
Work Phone:

Do you have any medical limitations or are you currently on and prescription medications?     Yes          No
If you selected Yes, please describe your conditions and alert us how to help you in an emergency situation:

I understand that by signing this application electronically, I am applying to volunteer at APC/Indiana Horse Rescue and understand that for any reason my application may be denied. I also understand that the information I've provided may be used to request a background check, including criminal records to verify personal information. By signing this application I am verifying that all information I've provided is accurate.

Electronic Signature:
Date:

PLEASE NOTE: You will be asked to sign your application upon your first visit to one of our facilities. If you are under the age of 18 years, you and you parent/guardian will be asked to sign the application as well!