Colorado Therapeutic Riding Center Mineral Road, Longmont, CO (303) FAX (303)

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1 Colorado Therapeutic Riding Center Mineral Road, Longmont, CO (303) FAX (303) Dear Prospective Intern: Thank you for your interest in interning at the Colorado Therapeutic Riding Center (CTRC)! CTRC is a wonderful place to learn about working with people with special needs, equine management, volunteer management, non-profit organizations, and more. Internships are tailored to meet the educational goals of the intern. Interns are often involved with multiple aspects of the program (horses, riders, volunteers, facilities, etc.) in order to experience how each component of an equine assisted services organization comes together to create a well-run center. The first step to interning at CTRC is to complete the internship application and , mail, or fax it to me; applications are accepted on a rolling basis. As Volunteer Coordinator, I may not be your internship supervisor, but I am the initial point of contact for all interns. Once we have received your application, we put great thought into determining if we can provide the type of internship that an intern desires: Do we have the necessary staff to supervise and give feedback? Does the intern s schedule work with our session schedule? Is the intern a good fit for our center? Can we provide the experiences necessary to meet the intern s learning goals? Because of the thought we put into whether we can host an intern or not, you may not hear from us immediately. If we are able to answer yes to the above questions, the CTRC staff member who is best suited to work with you will be in touch to arrange a phone interview. After the conclusion of the phone interview you will be informed of our decision. If offered an internship, your internship supervisor will work with you to set your schedule, ensure you receive all the necessary trainings applicable to your internship and complete the rest of the CTRC internship paperwork. Please note that we are unable to provide housing for interns who are coming from out of town, but there are often sublets available in Longmont (very close) or Boulder, which is only about 25 minutes away and where the University of Colorado at Boulder is located. There are often student sublets available. All CTRC internships are unpaid positions. If you have any questions, please do not hesitate to contact me. Thank you so much for your interest in our program! Thank you, Cari Lastick Cari Lastick Volunteer Coordinator Colorado Therapeutic Riding Center, Inc All rights reserved.

2 Colorado Therapeutic Riding Center Mineral Road, Longmont, CO (303) FAX (303) INTERN APPLICATION Thank you for your interest in an internship with CTRC! Please complete the following. Date: Name: Birth Date: Street Address: City: State: Zip: Mailing address: City: State: Zip: Home phone: Cell phone: (Please circle primary phone contact.) College/University currently attending (if relevant): Faculty Advisor (if relevant): Phone: Courses you have taken relevant to your internship, if applicable (please list title, not number): How did you hear about CTRC? Are you comfortable working around horses? Yes No Do you have horse experience? Little/none Some Considerable Please describe: Do you have training or experience working with people with special needs? Yes No Please describe:

3 Are you willing and physically able to handle physical labor, walk a part of the day, work in all weather conditions and lift at least 40lbs? Yes No If No, please explain: Have you ever been arrested for, or convicted of, a crime against a person or animal? Yes No Have you ever been listed on a registry for child abuse? Yes No What kind of supervision do you work best under? When do you need to know about your internship by? How many hours per week are you able to commit to this internship (15 minimum)? Available Start Date: End Date: What days and times are you available to intern? (Please check days and write in time(s)) Monday Tuesday Wednesday Thursday Friday Saturday Please write additional explanations if needed: If not participating in an equine internship, are you available on Saturdays from 8-3pm? Yes No During the course of your internship are there any days or weeks are you not available to intern? Yes No If Yes, please list: Do you have any animal or outdoor allergies? Yes No If Yes, please explain:

4 What goals are you hoping to accomplish during your internship time at Colorado Therapeutic Riding Center? Are there certain aspects of an equine assisted services center that you would like to focus? If your internship is for university credit, what are the universities requirements of the site supervisor? For example, are there required reviews, evaluations, periodic meetings or phone calls with the faculty advisor... It is important that CTRC knows all site supervisory responsibilities prior to agreeing to host an internship. Please list THREE people, who are not related to you, who can provide a personal or professional reference: REFERENCE 1: Name: Phone: Association: REFERENCE 2: Name: Phone: Association: REFERENCE 3: Name: Phone: Association: Internships may be terminated at any time by either the intern or The Colorado Therapeutic Riding Center (CTRC) and must be accompanied by a written statement for the reason of termination. CTRC will not be liable for the college credit or the grades received by the intern for the internship. Applicant Signature Date

5 Volunteer Consent & Release Form Consent for Emergency Medical Treatment In the event emergency medical aid/ treatment is required due to illness or injury while participating in the services of, or while being on property of, the Colorado Therapeutic Riding Center (CTRC), I authorize CTRC to secure and retain medical treatment and/ or transportation if needed. This authorization includes any treatment deemed necessary by a treating health care professional and includes but is not limited to x-ray, surgery, hospitalization, and medication. In addition, I authorize CTRC to release my/ my child/ my ward s record to any individual involved in medical treatment and/ or necessary transportation. Volunteers Name In Case of emergency, contact Phone or contact Phone Physician s Name Phone Health Insurance Name (optional) Policy # Date Volunteer Signature (or signature of parent or guardian if volunteer is under age 18) Liability Release WARNING Under the Colorado Law, an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to section , Colorado Revised Statutes. (Volunteer s name) would like to participate in the Colorado Therapeutic Riding Center (CTRC) program. I acknowledge the risks and potential for risks in riding and working with horses. However, I feel that the possible benefits to myself/ my child/ my ward are greater than the risk assumed. I hereby, intending to be legally bound, for myself, my heirs, assigns, executors and/or administrators, waive and release forever all claims for damages against CTRC, it s Board of Directors, Advisory Board, Instructors, Therapist, Aides, volunteers, employees, agents, and representatives of any kind for any and all injuries, damages, claims, demands, causes of actions, law suits, and/ or losses I/ my child/ my ward may sustain while participating in CTRC program. Date Volunteer s Signature (or signature of parent/ guardian if volunteer is under age 18) Photo Release (Optional) I herby consent to and authorize the use reproduction by Colorado Therapeutic Riding Center of any and all photographs and any other audiovisual materials taken of me/ my child/ my ward for promotional printed material, educational activities, exhibitions or for any other use for the benefit of the program. Date Volunteer Signature (or signature of parent/ guardian if volunteer is under age 18)

6 Colorado Therapeutic Riding Center Mineral Road, Longmont, CO (303) Fax: (303) CONFIDENTIALITY POLICY The Colorado Therapeutic Riding Center, Inc. (CTRC) recognizes the right of participants/riders and their families to have privacy and control over any information that might be personal or sensitive. In order to respect that right, CTRC has adopted the following policy regarding confidentiality. Those bound by the directives of this policy are ALL persons in any way connected with CTRC, including but not limited to: full and part-time staff, volunteers, board members, temporary employees, independent contractors, and instructor workshop/training/certification participants. Any person violating these policies will be subject to penalties ranging from reprimand to alteration of job responsibilities to termination to legal action. Information considered to be confidential includes all medical, familial, social, referral, personal, and financial concerns regarding a participant and/or his/her family. Such information is considered confidential regardless of how it is obtained, whether directly from the participant or family, CTRC staff, volunteers or others association with CTRC, or inadvertently from other sources, such as but not limited to a chart, computer screen or overheard conversation. Consent to disclose information to outside individuals or agencies, including photographs and videotapes, should be obtained in writing from the proper legal representative. Adults age 18 and over with development disabilities are presumed to be competent to give consent unless they have specifically been found incompetent in a court of law. In such a case, a substitute decision-maker would be assigned, and any consent must be obtained from that decisionmaker. I have read and understand the CTRC confidentiality policy as described above and agree to observe its principles. Date: Name: Signature: Signature of parent or guardian if under 18 years: