APEC 2025 Membership Application Form

Member Details:

Name*

First NameLast Name

Date of Birth*

Date of Birth

Mobile*

Contact Number

Home Address*

Street Address

Street Address Line 2

Suburb

Post Code

Email*

example@example.com

Do you suffer from allergies / medical condition?*

YesNo

If yes please provide details of condition action plan

PIC No*

property identification code (PIC) of where your horse lives - if unknown enter street address.

Emergency Contact Information:

Emergency contact name*

Adult or guardian that would attend hospital with the member - not the person that would collect horse.

Relationship to you*

e.g., partner, husband, wife, mum, dad etc.

Emergency contact phone No*

Membership Type (Refer to Schedule of Fees*

Adult Rider Ordinary (18 yrs & over)Adult Social (18 yrs & over)Junior Rider Ordinary (under 18 yrs)Junior Social (under 18 yrs)Parent / Guardian (18 yrs & over)Family Membership (includes up to 4 people from immediate family)

Insurance

Adelaide Plains Equestrian Club Incorporated ('APEC') has in place an appropriate public liability insurance policy which covers itself and you whilst you are at an APEC event. Being a member of APEC does not provide you with public liability insurance coverage outside of APEC events.

Accident and Horse Injury Management

In the event that you are injured whilst at an APEC event and are unable to attend to your horse, please provide contact details of a person we can contact to take care of your horse on your behalf.

This should not be the same person as your Emergency Contact identified for you.

Horse Emergency Contact Name*

Person who can collect your horse if you are injured.

Horse Emergency contact phone No*

Phone number of person who can collect your horse if you are injured.

In the event that your horse is injured at an APEC event, and you are unable to attend to your horse due to injury to yourself, please advise contact details for your vet:

Veterinarian Name/Clinic Name*

Please give the name of your preferred vet or veterinary clinic.

Veterinarian/Clinic Phone No*

Please provide the contact number for your preferred vet or veterinary clinic.

In the event that APEC is unable to contact your vet, you acknowledge and agree that APEC will seek veterinary attendance, at your cost, from the nearest available vet. APEC will follow the advice of the vet and shall not be held liable, financially or in any way whatsoever, for any such decision.

Confirmation and Acknowledgement

I confirm that all information contained in this Member Application Form is true and correct. I acknowledge that photographs may be taken of me at an APEC event and hereby authorise APEC to use these for advertising and promotional purposes, including, but not limited to, on the APEC website, Facebook, in newspaper articles and on APEC event flyers.

I confirm and acknowledge that any veterinary costs incurred as a consequence of injury to my horse whilst attending an APEC event shall be borne in full by me and that APEC shall have no liability for such costs. I accept that I must comply with the Constitution of the APEC and all other policies and procedures established by the APEC Committee from time to time, which are available on the APEC website. Failure to do so may result in the cancellation of my membership, for which

I acknowledge that I may forfeit any membership fee paid. I further accept that as a member of APEC, if requested, I agree to volunteer to assist in organising/setting up for at least one APEC event per annum.

Horse Sports are a Dangerous Activity

In consideration for being permitted to participate in any way in horse sport activities with the Adelaide Plains Equestrian Club Inc in the abovementioned calendar year, I, the undersigned, understand, acknowledge and accept that:

Horse sports are a dangerous recreational activity, and horses can act in a sudden and unpredictable (changeable) way, especially if frightened or hurt.
There is a significant risk that serious INJURY or DEATH may result from horse sport activities and in particular, this event.
I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the proprietors of the event organizer (hereinafter referred to as the "Releasee") or others and I voluntarily PARTICIPATE at my OWN RISK and assume sole responsibility for any injury, death or property damage I may suffer that arises from my participation in horse sport activities.
I understand and acknowledge the dangers associated with the consumption of alcohol or any mind-altering drugs before and during the activity and I take full responsibility for any injury, loss or damage associated with their consumption. I agree not to drink alcohol or take drugs prohibited by law before or during this event.
I agree to follow the directions of any event organizer or official and that any misconduct or refusal by me to follow any direction of any organizer or official can result in the CANCELLATION of my participation in the event and my immediate removal from my horse NO MATTER where that may occur. I further agree to abide by the Constitution or Rule Book of APEC and any further conditions of the APEC Insurer. I understand that any such non-compliance may result in injury, death and/or permanent disability and I agree to indemnify the Releasees against all claims made by any person as a result of my failure to comply.
I agree to wear an approved safety helmet in accordance with the Australian standards, less than five (5) years old and not having been damaged in any prior incident, at all times whilst riding and agree that I am solely responsible for ensuring that I wear a suitable helmet at all times and take sole responsibility for my actions.
I acknowledge that it is my responsibility to ensure that any equestrian equipment, saddlery or gear that I use is correctly fitting, safe and fit for purpose. I further acknowledge that APEC does not undertake gear checks of any equestrian equipment, saddlery or gear used by me.
I acknowledge that it is my responsibility to repair any damages to "horse yards" should my horse damage the yards in any manner. If I am unable to repair to an acceptable standard of the APEC committee, I will reimburse APEC reasonable repair costs.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless and agree not to sue the proprietors of APEC and/or APEC Insurer, theirs officers, officials, volunteers, coaches, agents and/or employees, other participants, sponsoring agencies, sponsors, state bodies, affiliated clubs and if applicable, owners and lessors of premises used to conduct the activities (all of whom are referred to as "Releasees") with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the Releasees or otherwise.
I understand that due to diseases, such as equine influenza, the Department of Primary Industries or other State or Commonwealth Government bodies may restrict or prevent the movement of horses, vehicles and personnel for a time period, otherwise known as a "standstill". I acknowledge that a standstill is a risk of participation and agree to pay any costs or expenses incurred by any person or organisation for and on behalf of my horse(s) as a result of the standstill.

Effect of this Document

I have had sufficient opportunity to read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without inducement of any kind. I understand that my signature to this document constitutes a complete and unconditional release of all liability of the Releasees, to the greatest extent allowed by law in the event of me and/or the children under my care, suffering injury or death.

In consideration of your accepting my participation, I hereby undertake to indemnify the organizing body, to the extent permitted by law, against all claims, losses, suits and damages made against or suffered by the organizing body by reason of any negligent act or omission on my part whilst attending, riding, driving or otherwise handling any horse at an APEC event, and I agree that any act or omission by me found in any action against APEC to be negligent shall be deemed to have been negligent for the purpose of any claim under this indemnity. Further, I agree to abide by, and ensure that any participant for whom I am a parent/guardian abides by: the APEC Constitution and/or Rule Book and any APEC Policies and Procedures, as prepared from time to time and available on the APEC website. all of the rules for any facility used by APEC for any event in which I participate regarding use of such facilities.*

By ticking this box, you are confirming that you have read, understood and agree to the membership application in full.

Signature of Member*

Name of Member*

Dated*

Date

For Participants of Minority Age (Under Age 18)

Ticking this box is to certify that I, as a parent/guardian with legal responsibility for this participant, acknowledge, understand and accept all of the above and consent and agree to his/her release as provided above by all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities arising from my minor child's involvement and participation in horse sport activities and in particular, this event, even if arising from the negligence of the Releasees.

Signature of Parent/Guardian

Printed Name of Parent/Guardian

Dated

Date

Payment to: Adelaide Plains Equestrian Club

BSB: 633000 ACC: 146455688

Schedule of fees can be found at www.adelaideplainsec.com.au

ABN: 98 280 324 304