Pony Club WA Showjumping Official Application

PONY CLUB WA SHOWJUMPING OFFICIAL

Application Form
Type of Application

□ Judge □ Course Designer

□ Trainee: A person has an interest in becoming a course designer and/or Judge and has limited or no experience

□ Accredited: A person who is either accredited with Equestrian WA as a course designer and/or judge or has completed their training through the Pony Club WA Officials Pathway and received formal confirmation of their accreditation

□ Renewal of Accreditation: A person who has been on the accredited list of officials whose accreditation has expired (every 3 years) and who wishes to continue being an accredited official. Accreditation will be reviewed on completion of the Pony Club WA Officials Pathway application or by providing Equestrian WA accreditation confirmation.

□ Provisional: A person who has over several years carried out the duties of a course designer and/or judge but has not completed the Officials Pathway accreditation
Title
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState Post Code
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Working with Children Number
Working with Children Expiry Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Pony Club WA Club
Pony Club WA Membership Number
Equestrian WA Membership Number
Do you have a copy of the current EA Showjumping Competition Rules and Regulations (including all amendments)? If no, please be reminded that this is a requirement. Please see the Equestrian Australia Website to download the EA Showjumping Competition Rules and Regulations for free.
Please list any other Pony Club WA or EA certificates of coaching or judging that you currently hold.
Do you currently compete in Showjumping competitions? If so, please specify the level at which you compete.
All Pony Club WA Judges and Course Designers must have attended a minimum of two Judge or Course Design Seminars in the previous three years. These may be Pony Club WA or Equestrian WA seminars. Please list all Seminars, Workshops or Instruction Schools attended in the past three years.
Please record your Officiating Experience (minimum two events in the past three years).
Signature
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

PONY CLUB WA SHOWJUMPING OFFICIAL