Provide us your information *required field First Name* Last Name* Company / Business Organization Phone*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 Name Date of Birth MM slash DD slash YYYY AddressSuburb Post Code ContactPhMobileEmail Name of parent or guardian contact Phone No. In case of emergencyAny Medical Conditions 2. Lesson TimesDay Time 2. Days AttendingDates attending:* Deselect All Please Note: All October dates are now full.Number of days Quantity* 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 AddressTelephoneFax Brief HistoryDiagnosisRelevant Medical Information General InformationNature of Disability Age of onset of Disability Height Weight Other relevant information SECTION 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 horse Quarterly worming of all horses ($500) Sponsor a Horse for a Year Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Credit Card Number Exp Date Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 CVV Code Cardholder Name Comments/Questions Δ