Volunteer

Join us to help kids gain confidence, overcome hurdles, and find renewed hope for tomorrow.

We provide a unique opportunity for you to work with both children and horses. But if you prefer to find other ways to help, we could use:

Grant writers
Website
Help at our fundraising events, including anything from helping with the food to setting up and manning registration tables.
Board of Directors (min. age 21)
Program assistants – working in the arena with the horses and the children (Min. age – 12)

Volunteer Application

Step 1 of 4

Name(Required)

First

Last

Address(Required)

Street Address

Address Line 2

City

State

ZIP Code

Work Phone

Personal Phone(Required)

Email(Required)

Birthday(Required)

Name of Parent/Guardian

(if under the age of 18)

Name

First

Last

Address

Street Address

Address Line 2

City

State

ZIP Code

Work Phone

Personal Phone

Email

Person to contact in case of emergency.

Name(Required)

First

Last

Address(Required)

Street Address

Address Line 2

City

State

ZIP Code

Work Phone

Personal Phone(Required)

Email(Required)

References:

List name/address/phone numbers of three (3) business/work/character references that are NOT related to you.

Name(Required)

First

Last

Address(Required)

Street Address

Address Line 2

City

State

ZIP Code

Phone(Required)

How Connected(Required)

Name(Required)

First

Last

Address(Required)

Street Address

Address Line 2

City

State

ZIP Code

Phone(Required)

How Connected(Required)

Name(Required)

First

Last

Address(Required)

Street Address

Address Line 2

City

State

ZIP Code

Phone(Required)

How Connected(Required)

By submitting this application, I affirm the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in the immediate dismissal.

Name(Required)

First

Last

Signature(Required)

Date(Required)

Parent/Guardian Signature:

(if under 18 years old)

Nebraska Department of Social Services Central Registry

I certify that the answers are given are true and complete to the best of my knowledge. I authorize investigation of all statements contained in the application as may be necessary in arriving at decision., I, hereby, understand, acknowledge and give my consent to having a background check with the following before services can be provided.

Nebraska Department of Social Services Adult/Child Protective Services
State Sex Offender Registry

Signature(Required)

Full birthday date:(Required)

Date(Required)

Parent Signature

(if applicant under the age of 18):

Emergency Contact information:

Name(Required)

First

Last

Phone(Required)

Name(Required)

First

Last

Phone(Required)

Volunteer Authorization for Emergency Medical Treatment

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 utilized by the program, I authorize LyonHeart Equine Assisted Learning to secure and retain medical treatment and transportation if needed.

Emergency Medical Treatment(Required)

I authorize LyonHeart Equine Assisted Learning to secure and retain medical treatment and transportation if needed.

I do not authorize LyonHeart Equine Assisted Learning to secure and retain medical treatment and transportation if needed.

Consent Plan:

This authorization includes x-ray, surgery, hospitalization, medication and any treatment procedure deemed “lifesaving” by a physician. This provision will only be invoked if the person below is unable to be reached.

Volunteer Name(Required)

First

Last

Address(Required)

Street Address

Address Line 2

City

State

ZIP Code

Signature(Required)

Date(Required)

Parent Signature

(if under the age of 18)

Non-consent Plan:

I do NOT give consent for emergency medical treatment/aid in the case of illness or injury during the process of receiving services or while being on the property utilized by the program.

In the event emergency treatment/aid is required, I wish the following procedures to take place:(Required)

Signature(Required)

Date(Required)

Parent Signature

(if under the age of 18)

Join us to help kids gain confidence, overcome hurdles, and find renewed hope for tomorrow.

Volunteer Application

Name of Parent/Guardian

Person to contact in case of emergency.

References:

Special Skills, Interests or Qualifications with education or horses.

By submitting this application, I affirm the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in the immediate dismissal.

Nebraska Department of Social Services Central Registry

Nebraska Department of Social Services Adult/Child Protective Services
State Sex Offender Registry

Emergency Contact information:

Volunteer Authorization for Emergency Medical Treatment

Consent Plan:

Non-consent Plan:

Give

Contact

Volunteer

Join us to help kids gain confidence, overcome hurdles, and find renewed hope for tomorrow.

Volunteer Application

Name of Parent/Guardian

Person to contact in case of emergency.

References:

Special Skills, Interests or Qualifications with education or horses.

By submitting this application, I affirm the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in the immediate dismissal.

Nebraska Department of Social Services Central Registry

Nebraska Department of Social Services Adult/Child Protective Services State Sex Offender Registry

Emergency Contact information:

Volunteer Authorization for Emergency Medical Treatment

Consent Plan:

Non-consent Plan:

Nebraska Department of Social Services Adult/Child Protective Services
State Sex Offender Registry