Provide us your information *required field First Name*Last Name*Company / Business OrganizationPhone*Email* Subscribe to our newsletter. Type of Enquiry*General EnquiryMembership EnrolmentCamp EnrolmentSupport UsVolunteersRequest an Appointment / Triage Camp Enrolment Form Section A: Membership Enrolment Form Support Us1. DetailsRiders NameDate of Birth Date Format: MM slash DD slash YYYY AddressSuburbPost CodeContactPhMobileEmail Name of parent or guardian contactPhone No. In case of emergencyAny Medical Conditions2. Lesson TimesDayTime2. Days AttendingDates attending:* Select All Tuesday 4th July Wednesday 5th July Thursday 6th July Tuesday 11th July Wednesday 12th July Thursday 13th July Please select each day you would like to attend. Number of days* Price: $ 125.00 Quantity: * Price is subject to change. * This fee is non-refundable once booking is made.Total $ 0.00 Section B: Personal, Parental or Guardian medical consent formMedical ConditionsYesNoMedical Condition Type Allergies Asthma Autism Bleeding tendencies Cerebral Palsy Cranial Shunt Diabetes Downs Syndrome Epilepsy Fainting Turns Flaccidity Heart Problems High/Low Blood Pressure Impaired Balance Impaired Bladder/Bowel Impaired Circulation Impaired Hearing (Deaf) Impaired sensation Impaired Sight (Blind) Impaired Speech Infectious Disease Carrier Intellectual Disability Skin Problems Spina Bifida Splints/ Braces/ Corset History of Aggressive behavior Any other medical condition Name of Medical Practitioner Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last AddressTelephoneFaxBrief HistoryDiagnosisRelevant Medical InformationGeneral InformationNature of DisabilityAge of onset of DisabilityHeightWeightOther relevant informationSECTION C – Required if you have medical conditionSelect Type of Donation*Bale of Hay ($15)Bag of Lucerne Chaff ($30)2 Bags of Pony Cubes ($50)Set of shoes for a horse ($100)Dentist for a horseQuarterly worming of all horses ($500)Sponsor a Horse for a YearCredit Card* American ExpressDiscoverMasterCardVisa Credit Card Number Exp Date Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 CVV Code Cardholder Name Comments/Questions Δ