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 Name*Date of Birth* MM slash DD slash YYYY AddressSuburbPost CodeContactPhMobile*Email* Name of parent or guardian contact*Phone No. In case of emergency*Any Medical Conditions*2. Lesson TimesDayTime2. Days AttendingDates attending: all dates are currently full* Select All Tuesday July 8th Wednesday July 9th Thursday July 10th Tuesday July 15th Wednesday July 16th Thursday July 17th Please note number of days attending in box belowNumber of days Quantity* Price: $ 150.00 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 formRisk Warning and Waiver of LiabilityConsent*Download Risk Warning and Liability agreement (PDF) I have read and agreed to the Risk Warning and Liability agreementMedical Conditions*YesNoMedical 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 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 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 CVV Code Cardholder Name Comments/Questions Δ