Special Riders volunteer - THE CARR CENTER

special Riders Volunteer form

* Indicates required field

Name *

First

Last

Phone Number *

Age (must be 14 years or older) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Last four digits of your social security number (if 18 and over) *

Email *

Please check dates you are available *

In case of an emergency, please contact:

Name *

First

Last

Phone Number *

In the event of an emergency, you give permission for medical care, such as contacting emergency squad. Further, The Carr Center will initiate efforts to contact your emergency contact.

Confidentiality Policy:
Information received concerning The Special Riders, their families and employees of The Carr Center is confidential and is not to be discussed with anyone outside of The Carr Center or the Special Riders Program. Any individual, contractor or agency that violates this policy will be held accountable and subject to disciplinary and/or legal action, which may include dismissal.

By signing, you agree to the Emergency Plan and Confidential Policy.

Signature *

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