Contact | Claremont Therapeutic Riding Centre

First Name*

Last Name*

Company / Business Organization

Phone*

Email*

Subscribe to our newsletter.

Type of Enquiry*

Camp Enrolment Form

Section A: Membership Enrolment Form

Support Us

1. Details

Riders Name*

Date of Birth*

Address

Suburb

Post Code

ContactPh

Mobile*

Email*

Name of parent or guardian contact*

Phone No. In case of emergency*

Any Medical Conditions*

2. Lesson Times

Day

Time

2. Days Attending

Dates attending:*

Select All
Tuesday, 22nd April
Wednesday 23rd April
Thursday 24th April

Please note number of days attending in box below

Number of days *

Price: $ 125.00

* 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 form

Risk Warning and Waiver of Liability

Consent*

Download Risk Warning and Liability agreement (PDF)

I have read and agreed to the Risk Warning and Liability agreement

Medical Conditions*

Medical Condition Type

Name of Medical Practitioner

Prefix First Last

Address

Telephone

Fax

Brief History

Diagnosis

Relevant Medical Information

General Information

Nature of Disability

Age of onset of Disability

Height

Weight

Other relevant information

SECTION C – Required if you have medical condition

Select 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 Express

Discover

MasterCard

Visa

Credit Card Number Exp Date CVV Code Cardholder Name

Comments/Questions

Contact Claremont Therapeutic Riding Centre

Provide us your information

Camp Enrolment Form

Section A: Membership Enrolment Form

Support Us

1. Details

2. Lesson Times

2. Days Attending

Section B: Personal, Parental or Guardian medical consent form

Risk Warning and Waiver of Liability

General Information

SECTION C – Required if you have medical condition

STABLES

POSTAL ADDRESS

Registered Charity
License Number: CC20307

Contact Claremont Therapeutic Riding Centre

Provide us your information

Camp Enrolment Form

Section A: Membership Enrolment Form

Support Us

1. Details

2. Lesson Times

2. Days Attending

Section B: Personal, Parental or Guardian medical consent form

Risk Warning and Waiver of Liability

General Information

SECTION C – Required if you have medical condition

Registered Charity License Number: CC20307

Registered Charity
License Number: CC20307