If you are under the age of 18 then please have a parent fill out this form on your behalf. Youth ages 8-15 are welcome to volunteer with a parent or guardian. Youth ages 16-18 are welcome to volunteer without a parent or guardian.
After filling out this form you will immediately get an email to sign up for Orientation/Training. Please look for that email and in your spam mail if you do not receive it. That email will have the signup.com link to sign up for an Orientation/Training date that best suits you.
please enter date of birth in the following format: 00/00/0000
**Please note that volunteers over 18 are required to submit a background check if working with children. A good site to obtain those is www.https://www.goodhire.com/personal-background-checks/. Please send the results to us. Parents of youth under 18 need to accept this waiver and photo release for their child.
Assumption of Risk and Responsibility Release of Liability & Consent for Treatment
North Carolina Horse Council Warning: "Under the North Carolina Law, an Equine Activyt Sponsor or Equine Professional is not liable for an injury to, or the death of, a participant in equine activites resulting exclusively from the inhearent risks of equine activies" Chaper 99E, North Carolina General Statues
Acknowledgement of Risks:
I hearby request that the participants named above be accepted onto the property of 3017 Brassfield Road, Creedmoor, NC and/or into the equine assisted therapy program, horsemanship skill building programs, volunteering, other on/off campus skill building programs operated by Shepherd Youth Ranch herein referred to as SYR and Ashley Boswell. I acknowledge that a SYR staff or volunteer member has fully explained to me the scope of the equine assisted therapy and/or horsemanship skill building activities, including the potential for injury which can occur from riding horses, working with horses or being involved in the therapeutic/learning activities that included horses. Because of the potential benefits of the equine-assisted programs, I hereby waive any claim, which the client or I may have against Ashley Boswell, SYR Board of Directors, or any SYR staff or volunteer arising out of injury the client may sustain while on the property and/or involved in the equine program. I further understand that under North Carolina General Satues law Chapter 99E, an equine professional is not liable for an injury to or the dath of, a participant in equine activities resulting from the inhearent risks of equine activities. The undersigned assumes the unavoidable risks inherent in all horse-related activites and non horse related activies resulting from the inherent risks of equine activities. The undersigned assumes the unavoidable risks inherent in all horse-related activities and non horse related activites, including but not limited to bodily injury and physical harm to rider, participant and spectator, hazards from uneven or unstable ground or road surfaces, trees, branches, rocks, stones, gravel, mud, water, and/or vehicles, other horse and riders, equipment failure, my ability to control or direct the animal, and the speed at whcih I proceed can pose a dangerous risk to my safety, that movement, noise , and contact with objects might frighten or cause an animal to move unpredictable and with force; that I may suffer accidents or illnesses in remote pleaces where there are no available medical facilities and that no warranty of any kind, express or implied, is being made as to the habits, disposition, suitability, nature, or physical condition of any animal. I realize that personal property may be lost or damaged, that certain foreseeable and unforeseeable events can contribute to the impredictability of the risks, dangers and hazards of the acivity, that wearing a helmet while riding a horse is a basic precaution and that I should ask about other potential risks, dangers and hazards recommended precautions and procedures.
Express Assumption of Risk and Responsibility:
In recognition of the inherent risks of the activity, which I and any minor children for which I am responsible, will engage in, including approaching, handling, mounting, riding and dismounting an animal, I confirm that I am (we are) physically and mentally capable of participating in the activity and using the equipment. I/We participate willingly and voluntarily and I assume full responsibility for personal injury, accidents or illness, including death. I assume all responsibility for damage to or loss of personal property as the result of any major accident that may occur.
I assume the risk(s) or personal injury, accidents and/or illness, including but not limited to sprains, torn ligaments and/or muscles; fractured or broken bones; eye damage, cuts, wounds, scrapes, abrasions, and or neck, head, and/or contusions; dehydration, oxygen shortage (anoxia), exposture and/or altitude sickness, head, neck, and/or spinal injuries; animal bite(s) or attack, inect bites, allergic reaction; shock, paralysis, and/or death, and acknowlege that if, during the activity, I/we experience fatigue, chill and/or dizziness, my/our reaction time may be diminished and the risk of accident, increased.
Covenant of Good Faith:
I recognize that SYR, SYR Board of Directors, Ashley Boswell, SYR Equine Specialists and Volunteers as provider of goods, and/or services, will operate under a covenant of good faith and fair dealing, but may find it necessary to terminate an activity due to forces of nautre, medical necessities or other problems; and/or refuse or terminate, that participation of any person you judge to be incapable of meeting the rigors or requirements of participating in the activity. I accept your right to take such actions for the safety of myself and/or other participants.
I hereby authorize any medical treatment deemed necessary in the event of any injury while participating in the activity. I either have appropriate insurance or, in it's absence, agree to pay all costs of rescue and/or medical services that may be incurred on my/our behalf.
In consideration of service or property provided, I, for myself and my minor children for which I am a parent, legal guardian or otherwise responsible, any heirs, personal representatives or assigns, do hereby release SYR INC., Ashley Boswell, SYR Board of Directors and other contract staff and volunteers both of their principles, directors, officers, agents emplyees and volunteers, family members, and each and every land owner, municipal and/or government agency upon whose property an activity is conducted, from all liability and waive any claim for damage arising from any cause whatsoever.
I (We) have read the forgoing acknowledgement of risk, assumption of risk and liability and release of liability. I understand that by signing this document I a may be waiving valuable legal rights.
COVID 19 WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
In consideration for receiving permission to BE ON PREMISES at Shepherd Youth Ranch (hereinafter the “Activity or Activities”), I, on behalf of myself and any minor child/children for whom I have the capacity to contract, hereby acknowledge and agree to the following: 1.I understand the hazards of the novel coronavirus (“COVID-19”) and am familiar with the Centers for Disease Control and Prevention (“CDC”) guidelines regarding COVID-19. I acknowledge and understand that that the circumstances regarding COVID-19 are changing from day to day and that, accordingly, the CDC guidelines are regularly modified and updated and I accept full responsibility for familiarizing myself with the most recent updates. 2.Notwithstanding the risks associated with COVID-19, which I readily acknowledge, I hereby willingly choose to participate in Activities. 3.I acknowledge and fully assume the risk of illness or death related to COVID-19 arising from my being on the premises and participating in the Activities and hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE (on behalf of myself and any minor children for whom I have the capacity contract) the Shepherd Youth Ranch, the founder, Board of Directors, employees and assigns (the “RELEASEES”) from any liability related to COVID-19 which might occur as a result my being on the premises and participating in the Activities. 4.I shall indemnify, defend and hold harmless the RELEASEES from and against any and all claims, demands, suits, judgments, losses or expenses of any nature whatsoever (including, without limitation, attorneys’ fees, costs and disbursements, whether of in-house or outside counsel and whether or not an action is brought, on appeal or otherwise), arising from or out of, or relating to, directly or indirectly, the infection of COVID-19 or any other illness or injury. 5.It is my express intent that this Waiver and Hold Harmless Agreement shall bind any assigns and representatives, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the above-named RELEASEES. This Agreement and the provisions contained herein shall be construed, interpreted and controlled according to the laws of the State of North Carolina. I HEREBY KNOWINGLY AND VOLUNTARILY WAIVE ANY RIGHT TO A JURY TRIAL OF ANY DISPUTE ARISING IN CONNECTION WITH THIS AGREEMENT. I ACKNOWLEDGE THAT THIS WAIVER WAS EXPRESSLY NEGOTIATED AND IS A MATERIAL INDUCEMENT THE PERMISSION GRANTED BY RELEASEES TO BE ON PREMISES AND PARTICIPATE IN THE ACTIVITIES.IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Wavier of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Agreement for full, adequate and complete consideration fully intending to be bound by same. IN WITNESS WHEREOF, I have signed this Waiver and Agreement under seal on this
I consent to and authorize the use and reproduction by SYR of any and all photographs and any other audiovisual materails taken of the volunteer for use in protional materials, educational activities, exhibitions, or for any other use for the benefit of Shepherd Youth Ranch, Inc.
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