Dunedin RDA Community Riding Application Form
Rider Request to participate in DRDAs Community Riding
Rider information
This information is required to enable Dunedin RDA to consider whether they are able to accept the prospective rider into their Community Riding. All information supplied will be considered confidential, and stored and used in accordance with the Privacy Act 2020.
Rider name
*
First Name
Last Name
Date of birth
*
-
Day
-
Month
Year
Date
Gender
*
Please Select
Male
Female
Non Binary
Prefer not to say
Estimated Weight
*
Estimated Height
*
Rider address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Riding Ability - Please indicate if rider has any previous riding experience
*
Parent/Caregiver to complete if Rider less than 18yrs of age
I understand that this information is required to enable the Dunedin RDA to consider suitability to participate in the Community Riding and final acceptance will be at the discretion of Dunedin RDA, and that referral does not guarantee entrance into a riding program.
Parent/ caregiver legal name
*
First Name
Last Name
Relationship to the rider
*
If parent please write parent
Phone Number
*
Please enter a valid phone number.
Email address for Parent/Caregiver
*
example@example.com
Date
-
Day
-
Month
Year
Date
Parent/caregiver signature
Submit
Should be Empty: