Volunteer Application

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After submitting the following form or downloading the PDF and sending it to us, we will be in contact with you about the next steps. Remember to read over the FGE policies and Release of liability. These forms will have to be signed before you participate in any activities on the farm. Thank you for considering Fifth Gospel Equine!

Volunteer Application PDF

FGE Policies PDF

Release of Liability PDF

Volunteer Application

(Please complete this form or download the PDF version at the bottom of this form and send it to Fifth Gospel Equine by email: fifthgospel7@gmail.com or mail to the office at 516 Twyla Drive, Lebanon TN, 37087.)

1.PERSONAL INFORMATION

Name: *

D.O.B. *

Gender *

Male
Female

Have you ever volunteered with Fifth Gospel Equine before? *

Yes
No

If yes, when? *

Address: *

City: *

State: *

Zip: *

Phone: *

Email: *

Best way to contact: *

Call
Text
Email

Occupation *

IF UNDER 18 years old please print Parent/Guardian Name: *

How did you hear about ‘Fifth Gospel Equine’? *

Have you volunteered with a therapeutic Equine program before? *

Yes
No

If yes, what program? *

2. UNIVERSITY/COMMUNITY SERVICE INFORMATION (only complete if applies to you)

If you are volunteering to complete university curriculum service hours, how many hours do you need to fulfill your requirement?

What university do you attend?

What major/class/program is this required for?

I wish to volunteer at Fifth Gospel Equine because:

3. SPECIAL SKILLS:

Please list any special skills that you could offer (carpentry, people skills, business skills, social media, networking, people management, communication, farming, equine skills, etc.) *

Please describe your general background (i.e. education, work experience) *

Degrees/Certifications?

Have you had previous experience working with horses? *

Yes
No

If yes, please describe:

Have you had previous experience working with people in recovery from trauma, addiction, and/or mental illness? *

Yes
No

If yes, please describe:

4. Area(s) of Interest

Please choose one: *

Fundraising
Horse Handler
Public Relations
Photography/Video
Grant Writing
Stable Management
Recruitment
Youth Board
Social Media Farm Help
Bible teacher
Advisory Board
Networking
Administration

Please indicate Days and times you are available and how often *

5. AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

Participants Name: *

D.O.B. *

Physicians name: *

Preferred Medical Facility: *

Health Insurance Company: *

Policy Number: *

Allergies to Medication: *

Current Medications: *

In the event of an emergency contact: *

1. Name *

Phone *

Relationship *

2. Name *

Phone *

Relationship *

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

Please choose one: *

CONSENT PLAN I DO give authorization that may include x-ray, surgery, hospitalization, medication and any treatment procedure deemed “lifesaving” by the physician. This provision will only be invoked if the person(s) above is unable to be reached.
NON-CONSENT PLAN I Do Not give my consent for emergency medical treatment aid in the case of illness of injury during the process of receiving services or while being on the property of the agency.

If chose Non-consent - In the event emergency treatment is required, I wish the following procedures to take place *

Participant’s Signature (we will get this in person if you are not able to virtually):

Date: *

If under 18 years of age, parent/guardian signature required below.

Leave this field empty

fifthgospel7@gmail.com

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