WHPC SENIOR Camp Form 2024

WHPC Senior Camp Form 2024

Held at Whitfield Farm, CV37 7PN - Any issues with this form not working please contact Louise on 07528553108
Name of Parent*

First NameLast Name
Address (put post code below)*
Post code*
Mobile number *
Email*
example@example.com
Emergency Contact Number*

Child details *

	Name of child	Child DOB	Is this their first camp?
Child 1

Pony / horse details*

	Name of Pony	Age of pony	Height	Experience and manners of pony
Child 1

Most recent test passed Please write name of most recent efficiency test passed (eg D Test D+ Test, C Test, or None)*
Have you passed your riding and road safety test?*
Please select your child's level of riding*
To help us design a camp to meet the needs of our riders, please let us know what is most important to your child.
Just having fun

1

2

3

4

5

1 is Worst, 5 is Best
Stable Management & Working towards the next test (eg C test / B Test)

1

2

3

4

5

1 is Worst, 5 is Best
Specialist Training from an expert in their ridden field (e.g. Cross Country / Dressage)

1

2

3

4

5

1 is Worst, 5 is Best
Fun lessons such as jumping gymnastics, fancy foot work

1

2

3

4

5

1 is Worst, 5 is Best
Educational talks such as fitness training, farrier talk,

1

2

3

4

5

1 is Worst, 5 is Best
Having a go at something new (e.g. polo cross, shooting for tetrathlon, side saddle)

1

2

3

4

5

1 is Worst, 5 is Best
Please provide any information that will help us group your child (eg they are nervous, confident, have ridden with xx child before, or are good friends with xx*
Straw bedding will be provided in all stables. if this is not suitable please make arrangements to bring your own bedding. Are you bringing your own bedding?
I hereby authorise photographs/videos/other images of my son/daughter taken by the press/outside agencies, official pony club photographers to be published in the press and on the internet for publicity purposes. I understand that the pony club will select images for publication with care and respect for those shown.*
I give consent for the personal data on these forms (including medical consent) to be held in a secure place up to and including the duration of camp and I am happy to receive information about camp via my email address.*

MEDICAL CONSENT FORM

This form is to be completed by the person with parental responsibility for the Pony club Member (s).

Doctors Details*

	Doctors Details
Name of Doctor
Name of Surgery
Surgery Phone Number

Box 1: please list any disease, illness, condition, allergy that your child suffers from. Please indicate what reasonable adjustments can be made at camp to support their well being
Please list any PRESCRIBED medications that your child needs to take while at camp. Dose, frequency, dates must be listed in the section below
Religion, if relevant to Medical Treatment (or write N/A)*
Are there any problems of which the Safeguarding Officer should be made aware of? Please give details or write None.*
Does your child carry an adrenaline auto-injector? If so for what reason and what type and dose?*
Immunisations: Has your child received all expected immunisations (e.g Tetanus) If no what has been missed*
Medicines Administration by Member Of Staff Or Member

Whilst my child is away, I authorise you to give the following medicines to my child. Please state if your child carries and takes their own supply of medication e.g. asthma inhalers, contraceptive pills / implants.

All the medicines specified below have been prescribed by a registered and licensed medical practitioner and will be provided in the original packet / box / bottle with the child’s name and date of birth clearly marked. I agree that the medicines are necessary for my child, that they will be given without intending harm to the child and I indemnify The Pony Club or its Branches / Linked Centres against any loss or claim associated whatsoever with the administration of the medicines specified below.

Please list any Medicines your child needs or can be given. Please use the additional box below if extra space is needed

	Describe
Name of Medicine
Strength
How much to give (dose)
Type (liquid, tablet, inhaler)
When to give dose (time)
Any other information

I authorise the person in charge or their designated deputy to give up to 2 doses of paracetamol of a dosage suitable for the age and weight of my child in a form suitable for my child. I understand that on the administration of the second dose I will be contacted regardless of the time of day or night.*
My child is allergic to the following medicines (please state none if no known allergies). If this box is left blank no medication will be given*
In the event of my daughter / son requiring emergency medical or dental treatment whilst taking part in the Pony Club activity as described above, and an Officer or other responsible adult being unable to contact either myself or other person with a parental responsibility for my daughter / son, I hereby authorise the District Commissioner / Centre Proprietor or other Official of the Pony Club to obtain such medical or dental treatment for my child as they, in their absolute discretion, think necessary after consultation with a medical or dental practitioner. This authority extends to all medical and dental treatment including the giving of an anaesthetic where necessary.

Data provided will be stored and used in line with current data protection regulations.

FINALLY, WHILST EVERY CARE IS TAKEN, THE OFFICIALS OF THE PONY CLUB CANNOT BE HELD RESPONSIBLE FOR ANY LOSS, DAMAGE OF ACCIDENT TO SPECTATORS, MEMBERS, THEIR PONIES OR EQUIPMENT WHILST AT CAMP.
Signature*

Clear
Print name*

First NameLast Name
Role / Relationship to child (e.g. Mother / Father / Legal Guardian)*
NO APPLICATION WILL BE ACCEPTED UNLESS THE SUBSCRIPTION FOR THE CURRENT YEAR HAS BEEN PAID ALONG WITH CAMP FEES

PLEASE SUBMIT THIS FORM AND THEN MAKE CORRECT PAYMENT ONLINE

SENIOR CAMP FEES £375

EARLY BIRD DISCOUNT: £350 (if paid before June 20th 2024)

BACS Pament details are (New details)

Sort code - 05-02-00

Account no - 29914573

Account Name - Warwickshire Hunt Pony Club

Please make ref as follows CAMPSURNAME eg CAMPDANCER
Should be Empty:

WHPC Senior Camp Form 2024

Parents help and duty rotas

MEDICAL CONSENT FORM