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 AttendingDays Attending * Camp dates subject to changeNumber of days* Price: $ 100.00 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)Quarterly worming of all horses ($500)Sponsor a Horse for a year ($1000)Credit Card* American ExpressDiscoverMasterCardVisa Credit Card Number Exp Date Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 CVV Code Cardholder Name Comments/Questions This iframe contains the logic required to handle Ajax powered Gravity Forms.