Volunteer Registration and Liability Volunteer Registration Your Name * Your Name Your Name Your Name Group Name (if you are registering as part of a group) Preferred Gender Pronouns * Street Address * Street Address Street Address Street Address Street Address Street Address Street Address Date of Birth * Year Started at Main Stay * T-Shirt Size * Phone (home) * Phone (work) * Phone (mobile) * Your Email * Please list any medical information which we would need to know in case of an emergency: What form of communication do you prefer? * Phone Call Text Email Please indicate (yes or no) if your contact information is different than last * Yes, it is the same No, it has been updated Medical Information in case of emergency: * Emergency Contact (name & phone): * As a volunteer at Main Stay Therapeutic Farm, your time is priceless to us in so many ways. Volunteer hours are not only essential to Main Stay’s operations, but also for grants and other funding opportunities. Therefore we ask that you enter your hours each time you come to Main Stay. If you have any questions, please call/text or email the Volunteer Coordinator at 815-382-9374 or [email protected]. Thank you for your gift of time! Liability Release Your Name * Your Name First First Last Last I acknowledge the risks and the potential for risks of attending lessons or activities around horses and other farm animals inside and outside the Main Stay facility. However, I feel that the possible benefits are greater than the risks assumed. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Main Stay Therapeutic Farm, Inc., its Board of Directors, instructors, therapists, aides, volunteers and/or employees for any and all injuries and/or losses I/my minor children present may sustain while participating and attending activities in a Main Stay Therapeutic Farm, Inc. program. Under the Equine Activity Liability Act, each participant who engages in an equine activity expressly assumes the risks of engaging in and legal responsibility for injury, loss, or damage to person or property resulting from the risk of equine activities. ~IL PWA-89-0111~ Date * Signature * signature keyboard Clear *If under 18 a parent of guardian must sign. If you are human, leave this field blank. Next Volunteer RegistrationVolunteer AvailabilityVolunteer Interest