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Registrations2018-11-09T14:23:42+00:00

REGISTRATION

Personal Details

Preferred Name*

Surname*

Gender*
BoyGirl

Age at Camp*

Date of Birth*

Weight* (approx. kg)

Street Address*

Suburb/City*

State*

Postcode*

Telephone*

Mobile*

Email*

Camp Dates

Please see our Home Page for current dates and availability.

Arrival Date*

Departure Date*

Riding Experience*

Never RiddenBeginnerNoviceIntermediateAdvanced

Medical Details

Medicare Number*

Tetanus Injection*: YesNoUnsure

Swimming Ability* NoneStruggleComfortableStrong

Medical Conditions*

Medication Required

Transport Details

Kiah Bus to Camp

Kiah Bus Home

Private Transport

Payment Details

Payment*
7-Day ($950)Weekend ($495)Day Trip ($130)

Bus Fare*

Riding Boot Hire*
Please note that all children must have suitable boots for riding with heels and smooth soles.

Special Diet*

VegetarianGluten FreeLactose FreeVeganOther (please specify below)

Kiah Park Shirt $37

Kiah Park Jumper $47

General Information

Permission to take photographs of your child?* YesNo

Where did you hear about us?*

Other

I would like to bunk with: (This will be accommodated wherever possible and depends 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.

By ticking this box I agree to the Terms listed above.* Agree

Do we have permission to administer any medication provided by you?* YesNo

Do we have permission to administer panadol if necessary?* YesNo

Parent's Name*

Any further comments, information or special requirements, please let us know below.

* An asterisk indicates a required field.

PLEASE NOTE: If you would prefer to use a hard copy form, please print the Registration Form below and submit as an attachment via email.

Download Registration Form