Own Your Own Pony Enrolment Form

Own Your Own Pony Holiday Programme Enrolment Form

Cancellation and booking policy: Minimum 1 week notice must be given for cancellation, otherwise the full fee will be charged. Your child is only booked in once we receive the enrolment form and payment of $70 per day. We will contact you to confirm your booking.

Riders name *

First name

Last name

Riders address *

Address line 1

Address line 2

Town/Suburb

City

Postcode/Zip

Home phone

Cell phone *

Email address *

Date of Birth *

Gender *

Holiday Programme Required

Please indicate which holiday programme you are interested in.

Number of days required

Please advise how many days you are interested in.

Please advise which level your child's riding experience is at:

Riding Experience *

Parent/Guardian Name *

Parent/Guardian Relationship *

Please provide two Emergency Contacts (different to the Parent/Guardian Name):

Emergency Contact 1 Name *

Emergency Contact 1 Relationship *

Emergency Contact 1 Phone No. *

Emergency Contact 2 Name *

Emergency Contact 2 Relationship *

Emergency Contact 2 Phone No. *

Apart from Parent/Guardian who is allowed to collect your child from our programme:

Pick up Person Name

Additional Information:

Is your child the subject to any custody or access orders:

Custody or Access Orders *

Custody Details

Please advise if we need to know anything important regarding Custody or Access Orders

Allergies *

Medication *

Disability *

If yes to above please indicate *

Please advise what Allergies/Medication or Disability your child has

Publicity Permission *

I give permission for the Tauranga RDA Group to take still or moving photographs of the named participant. These may be used for publicity purposes for RDA.

Tauranga District Group Riding for the Disabled Ass. Inc. (RDA), their staff and volunteers will not be responsible for any loss, accident or injury to any person or property while present on RDA grounds or while using RDA horses. Tauranga RDA reserves the right to discontinue the course for any child who does not adhere to the rules and is seen to be a risk to other riders, volunteers or our horses. No refund will be given should this situation arise. In the event of an emergency or accident I consent to the programme staff taking whatever steps are necessary, including giving first aid and if required calling an ambulance to ensure the safety and well-being of my child/ren. I consent to meeting any associated costs for emergency treatment. MSD may look at this personal information for audit purposes. Cancellation and booking policy: Minimum 1 week notice must be given for cancellation, otherwise the full fee will be charged. Your child is only booked in once we receive the enrolment form and payment of $70 per day. We will contact you to confirm your booking.

I agree/disagree to the above statement *

Please indicate from the drop down box if you agree or disagree to the above statement