Medical standards for activities & events Variation Consent Application

Medical standards for activities & events Variation Consent Application
Submitter's contact details *

First NameLast Name
Email*
example@example.com
Club/Zone name*
State Email
example@example.com
State*
Name of the event*
Start date of the event*

DayMonthYear
End date of the event*

DayMonthYear
Location of the event*
How many riders will be entered in each competition? (eg Dressage 40 riders)
According to the Framework for Medical Services at Pony Club® events, what maximum level of medical services should be provided.*
What providers have you contacted, and what other steps have you taken, in an attempt to provide the required level of service? *
What has been the barrier to providing the required level of service?*
What alternative service are you proposing? Please state what competition is occurring in each session and provide the name of the service and who will be providing it.

For example, 1 First Aid Officer HLTAID014 provided by St John Ambulance. 1 First Aid provided by Sue Brown who is a registered general practice nurse

If all sessions are the same - eg Saturday am and Saturday pm - then you only need to complete Session 1
What competition is occurring in session/day 1?*
What medical services are proposed?*
What competition is occurring in session/day 2?
What medical services are proposed?
What competition is occurring in session/day 3?
What medical services are proposed?
What competition is occurring in session/day 4?
What medical services are proposed?
Please attach a copy of the draft schedule for the event.*

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Where is the nearest hospital to the event? Specify the number of km. *
Please attach aerial map of the event grounds, the hospital and the local area.

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What level of emergency services are provided at this hospital?*
Please mention any additional information here.
Please attach any additional documents.

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Should be Empty: