Refuge Farms home of "Horses Helping..."

Volunteer Registration



Today's Date:
Month:   Day:   Year:

Age (please select one):

Date of Birth:
Month:   Day:   Year:

First Name:      Last Name:  

Street Address:  

City:     State:    Zip Code: 

Email Address: 

Occupation (please be specific): 
Employed    Not Employed   Student   Retired
Telephone Number (include area code): 
Home   Cell   Business

Best time to call?

Alternate Telephone Number (include area code): 
None   Home   Cell   Business

My last tetanus shot was:
Month:   Year:   [Will need documentation by MD or health clinic.]

I don't remember
Any known allergies?   YES (list below):   NO known allergies


Any medical conditions?   YES (list below):   NO medical conditions


Any special accommodations?   YES (list below):   NO special accommodations


Emergency Contact Information

First Name:      Last Name:  

Relationship:  

Emergency Contact Telephone Number (include area code): 
Home   Cell   Business

Alternate Emergency Contact Telephone Number (include area code): 
None   Home   Cell   Business



How did you find out about Refuge Farms?


Comments:
I have read and AGREE to abide by The Ways of THE FARM.
I have read The Ways of THE FARM and DO NOT want to continue the registration process.

   



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