Age at Camp*
Date of Birth*
Weight* (approx. kg)
Please see our Home Page for current dates and availability.
Tetanus Injection*: YesNoUnsure
Swimming Ability* NoneStruggleComfortableStrong
Kiah Bus to Camp
Kiah Bus Home
---Both WaysTo CampHome
7-Day ($985)Weekend ($528)Day Trip ($140)
---One Way ($33/$35)Both Ways ($66/$70)None
Riding Boot Hire*
Please note that all children must have suitable boots for riding with heels and smooth soles.
---7-Day ($20)Weekend ($20)Day Trip ($5)None
---None7-Day Camp ($100)Weekend Camp ($80)Day Trip ($20)
Please specify your child's dietary requirements:
Kiah Park Shirt $37
Kiah Park Jumper $47
Permission to take photographs of your child?* YesNo
I would like to bunk with (accommodated wherever possible, depending on on age, etc.):
Where did you hear about us?* Been BeforeFriends/Word of MouthGoogle SearchFacebookSchool NewsletterKids on the CoastOther (please specify below)
If you would like us to email you a voucher to present to your child, please complete the following:
Who is the voucher from?
Please supply a short message you would like us to add:
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
Any further comments, information or special requirements, please let us know below.
* An asterisk indicates a required field.
Please leave this field empty.
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.