STAT®️ Ligonier Therapeutic Center - Volunteer Form

Volunteer Application

Please correct the errors described below.

Welcome to STAT®️! Volunteers are at the heart of what we do and who we serve

You have come to the right place if you enjoy helping others or are searching for some way to make a difference.

What is STAT®️ Inc?

STAT®️ provides a broad range of equine assisted services for adults and adolescents to include Physical Therapy, Occupational and Speech-Language Therapy on horseback, adaptive riding lessons, Horsepowered Reading/Math, and Equine-Assisted Learning (EAL) to include EAGALA (Equine Assisted Growth and Learning Association) and the O.K. Corral Series modalities.

STAT®️'s Safety Policy

Your Contact Information:

Please fill in all the information below, attach (upload) required clearances (Child Abuse Clearance and PA State Police Background Check) at the end of this Application.

Volunteers are required to be 18 years or older. (Proof of age will be required if you are under 21).

Home Address

with apt number if applicable
Please list any restrictions (i.e., weight lift restriction, movement restrictions), allergies or condition that may affect you during the time at which you are volunteering (easily fatigued, asthma, allergic to bee stings, or any surgeries or conditions that STAT team members would need to be notified of for safety of clients, horses, or in the event of an emergency)
Please write the full name and phone number or email of a professional reference and your relationship to this individual. (i.e., employer, supervisor, mentor, teacher, etc.) and how long you've known them. In writing in this individual's name and contact information, you are giving STAT permission to contact this person, to ensure compliance with STAT privacy and confidentiality practices and policies.
Please write the full name and phone number or email of one unrelated personal reference and your relationship to this individual. (i.e., neighbor, know from volunteering elsewhere, etc.) and how long you've known them. In writing in this individual's name and contact information, you are giving STAT permission to contact this person, to ensure compliance with STAT privacy and confidentiality practices and policies.

**Consent to Obtain Criminal Information from Volunteer Applicant** This Consent to Obtain Criminal Information ("Consent") is executed by Applicant, residing at Applicant's Address (above), hereinafter referred to as "Applicant," in favor of STAT Inc., a 501c3 public charity, located at 24 Stom Rd and 22 Horsepower Miracles Lane, both in Ligonier, PA 15658, hereinafter referred to as "Organization."

Purpose: The purpose of this Consent is to authorize the Organization to obtain and verify criminal information related to the Applicant as part of its volunteer applicant screening process.

Authorization: The Applicant hereby consents to and authorizes the Organization to request, obtain, and use any information regarding the Applicant's criminal record, including but not limited to information from local, state, and federal agencies. This information may include: - Criminal background checks - Arrest records - Convictions or other relevant criminal history information

Use of Information: The information obtained will be used by the Organization solely for the purpose of evaluating the Applicant's suitability for volunteer work and to ensure the safety and security of those who work for the Organization, those who the Organization serves, the property owner, as well as the animals that reside on the properties.

The Organization agrees to maintain the confidentiality of any criminal information obtained and will not use it for any other purpose. However, decisions can be made based on information included in criminal background checks and criminal history; i.e., an Applicant with any level of abuse to humans or animals will not be appropriate for a team member role of any level.

Release of Liability: The Applicant releases the Organization, its agents, employees, and representatives from any and all liability, claims, or demands that may arise from the acquisition, use, or release of criminal information obtained pursuant to this Consent, provided such use is in accordance with applicable laws and regulations.

Duration: This Consent shall remain in effect until the Organization completes its volunteer screening process or until the Applicant revokes it in writing, whichever comes first. Revocation of this Consent does not affect the information obtained prior to revocation.

Acknowledgment:

The Applicant acknowledges that they have read and understood this Consent and voluntarily agree to its terms. The Applicant understands that refusal to provide consent and/or content of the gathered information may affect their eligibility to volunteer with the Organization.

    Please upload a file

    This contact form is received by designated STAT®️ staff member(s) and your responses remain confidential. We are a small staff and we will do our best get back to you within 3 to 5 business days.

    If you have questions, please contact our CEO, Catherine Markosky at 833-328-8728 or email: cmarkosky@statinc.hush.com

    By submitting this form you give permission for STAT®️ staff to call/email you to briefly discuss the information on the form and explore service offerings. Submission of this form does not constitute a relationship with STAT®️, STAT®️ Staff, etc., and is inquiry only.

    Your information will be encrypted.

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