After submitting this form, you will be contacted to confirm your booking.

Personal Details
Name
Boy or Girl
 Age Birthday
Street Address
Suburb/City
State
 Postcode
Telephone
 Alt. Phone
Email*

camp dates
arrival / /20 to / /20
riding experience - able to: (please tick applicable)
medical details
Medicare number
Tetanus: yes no swimming: can swim cannot swim
Allergies:
transport
Bus
Pick up Point Drop off Point

Private
To & From camp
Drop Off to camp
payment
TO CONFIRM YOUR BOOKING A DEPOSIT of $100 must be paid.
We will contact you with payment details.
Payment Method
(How will you be paying?)
Camp Fee
 
Bus Fare
 
Boot Hire - $5 - Weekend
$15 - 7 Days
 
Kiah Park Shirt - Size $37
Kiah Park Jumper - Size $47
 
Less Deposit Paid $100
Balance
 
BALANCE must be paid prior to camp or at drop off
FEES CAN BE PAID BY CHEQUE, MONEY ORDER, DIRECT DEBIT OR CASH
(No eftpos facilities available)
other
Do you require a childcare receipt: Yes No
WHERE DID YOU HEAR ABOUT THIS CAMP?
I would like to Bunk with: (This will be accommodated wherever possible and will depend on age similarity etc)
TERMS
We acknowledge that while all reasonable care will be taken of our child/children while at Kiah Park Holiday Camp, we are aware that there are inherent risks with horse riding and any other outdoor and indoor activity and that accidents and illnesses can occur. We authorise any medical assistance considered necessary and agree to meet all costs involved. We further declare our children to be in good health (excepting special medical condition described above) having no other ailment likely to be detrimental to the health of other children. Owners and staff of Kiah Park will not be responsible for any accident or injury caused through any child deliberately disregarding any rules, directions or orders. Children must be aware that these are in place for safety reasons.

Do we have permission to administer any medication provided by you? Yes No
Do we have permission to administer panadol if necessary? Yes No

By Ticking this box I agree to the Terms listed above *
Parents Full Name
Any further comments, information or special requirements, please let us know below
Enter Code

(*Required Fields)

578 Beenham Valley Road, via Gympie 4570. PH: 5486 6166. info@kiahpark.com.au