Kandanga Stables - Confidential Riding Application and Medical History Form

  • Confidential Riding Application and Medical History Form

  • I agree to the following:*
  • Riding experience - indicate below the number of times the rider has ridden in total*

  • In the case of any emergency the following information is intended to assist:

    Name and telephone numbers of contact people.** Legal gardian details must be provided if rider is under 18 years of age

  • Format: 0000 000 000.
  • Format: 0000 000 000.
  • Format: 0000 000 000.

  • Are there any learning difficulties that need to be discussed, so the Instructors/Guides are able to accommodate accordingly?

  • Do you (or your child) suffer from any of the following pre-existing medical or other conditions below?*
  • Please tick: Any pre-existing medical or other condition/s that may affect or risk other persons or myself.

  • Allergies

  • Do you (or your child) suffer have any allergies?*

  • Tetanus Immunisation

  • It is particularly important that people dealing with horses are immunised against tetanus. Tetanus is normally given at five years of age as Triple antigen or CDT and at fifteen years of age as ADT. 

  • Medication

  • Consent To Medical Attention

  • I authorise the instructor in charge to administer first aid and call an ambulance. I agree to bear any cost thereby incurred.

  • Date*
     / /

  • Signature of Legal Guardian (if participant is U/18)

  • Privacy Statement – Privacy Act 1998

  • By completing this form you are supplying the Provider with personal information about yourself. This information is needed to ensure your safety during your time with us. The Provider is required to collect this information by our insurance company and by the department of Workplace Health and Safety. This information you provide will not be supplied to any other organisation or used for any other purpose than that which is stated above

  • Should be Empty: