Designated Responsible Person for Club Activities

This form can be used for clubs holding a rally/muster day, clinic, lessons etc that may not have an accredited coach available.

As the Designated Responsible Person Nominee, you agree to take responsibility for the safety and welfare of riders and horses on the day of the event, including ensuring First Aid help is available as per the Pony Club Medical Framework, and any incident reports are completed for rider falls.

Approved accredited coaches include current Pony Club Australia (PCA) Preliminary Coach, PCA Level 1 Coach, PCQ Level C or above, NSW Bronze or Silver coach.

To ensure your club and committee are insured for personal accident and public liabilty under the Pony Club Australia Insurance Scheme, please use the below form to advise us of the club's Designated Responsible Person.

Name

First NameLast Name

What state are you from?

What Club are you from:

What is the role you hold at your club?

What Zone are you from?

What is your Pony Club Member ID? (JustGo membership number)

Email

example@example.com

Phone Number

Please enter a valid phone number.

Do you hold any of the following credentials?

Is this application for an ongoing request or a specific event day?

Ongoing requestSpecific Event Day

If for a specific event day, please nominate the date:

Please list any other instructors at your club that may not hold a PCA or EA coaching qualification*

Do you agree to ensure that riders and horses are adhering to Pony Club Australia's safety and welfare policies at your club?

YesNoMaybe