Name_______________________________________________________ Date_____________________________

Address (PO Box/Street)_________________________________________________________________________

City, State, Zip_________________________________________________________________________________

Phone #____________________________________ Cell #______________________________________________

E-mail address_________________________________________________________________________________

Age_______________ Date of Birth__________________________________________      

Emergency Contact Name______________________________________ Relationship_______________________

Phone numbers_________________________________________________________________________________

Do you have any medical or physical conditions that would affect your participation with ESS? Yes    No

If yes, please explain:____________________________________________________________________________


Days and times that you are available to volunteer:____________________________________________________

Best way to reach you / best time to call if by phone:__________________________________________________

Please write a paragraph on the reverse side of this page explaining why you want to volunteer with ESS.

ALL: Sign attached liability forms and releases.  MINORS: Parent/guardian must sign consent form.

Use reverse side of page for explanations on any of the following:

HORSE EXPERIENCE (Circle all that apply):

None   some     novice    intermediate      advanced      breeder      trainer       other ________________

Own horse/s          Owned a horse             Have never been          Comfortable              Uncomfortable       

                                in the past                  around horses         around horses              around horses

Western      English     trail riding      jumping       4-H     Pony Club     basic handling       leading     grooming

Other (please specify and explain):_________________________________________________________________


MY INTERESTS (Circle all that apply):

Today only                 weekly visits                     occasional/monthly visits   

Membership               future board member         supporter/donor   

Fundraising                outreach/public relations   

Horse trainer               horse handling                  horseback riding lessons         therapeutic programs

Horse grooming          horse care/feeding             cleaning stalls, grounds           fencing repairs      yard work

Other (please specify):___________________________________________________________________________

Equine Spirit Sanctuary is a non-profit, volunteer-based healing center that believes in responsible horse care and ownership. ESS is dedicated to the safety and welfare of all equines. ESS, through equine rescue, rehabilitation, relocation or permanent retirement, along with education, promotes a healthy relationship between equines and humans.

How will your volunteer time help support the ESS mission statement? (use reverse side for your answer)