REGISTRATION

    Personal Details

    Preferred Name*

    Surname*

    Gender*

    BoyGirl

    Age at Camp*

    Date of Birth*

    Weight* (kg)

    Street Address*

    Suburb/City*

    State*

    Postcode*

    Telephone*

    Mobile*

    Email*

    Camp Dates

    Please see our Home Page for current dates and availability.

    Arrival Date*

    Departure Date*

    Riding Experience*

    NoneWalkLearning to TrotTrotting WellLearning to CanterCantering WellAdvanced

    Medical Details

    Medicare Number*

    Tetanus Injection*: YesNoUnsure

    Swimming Ability* NoneStruggleComfortableStrong

    Medical Conditions*

    Medication Required

    Transport Details

    Kiah Bus to Camp (no bus for weekend camps)

    Kiah Bus Home (no bus for weekend camps)

    Private Transport

    Payment Details

    Payment*

    7-Day ($1045)Weekend ($565)Day Trip ($195)

    Bus Fare*

    Riding Boot Hire*

    Please note that all children must have suitable boots for riding with heels and smooth soles.

    All standard meals are included. Please select if you require a Special Diet*

    Please specify your child's dietary requirements:

    General Information

    Permission to take photographs of your child?* YesNo

    Permission to upload images of your child taken at Kiah Camp on Kiah Park Horse Riding Camp face book, website and/ or instagram?* YesNo

    I would like to bunk with (accommodated wherever possible, depending on on age, etc.):

    Where did you hear about us?*

    Other

    Gift Vouchers

    If you would like us to email you a voucher to present to your child, please complete the following:
    BirthdayChristmasOther

    Who is the voucher from?

    Please supply a short message you would like us to add:

    Terms

    We acknowledge that while all reasonable care will be taken of our child/children while at Kiah Park Holiday Camp, we are aware that there are inherent risks with horse riding and any other outdoor and indoor activity and that accidents and illnesses can occur. We authorise any medical assistance considered necessary and agree to meet all costs involved. We further declare our children to be in good health (excepting special medical condition described above) having no other ailment likely to be detrimental to the health of other children. Owners and staff of Kiah Park will not be responsible for any accident or injury caused through any child deliberately disregarding any rules, directions or orders. Children must be aware that these are in place for safety reasons.

    By ticking this box I agree to the Terms listed above.* Agree

    Do we have permission to administer any medication provided by you?* YesNo

    Do we have permission to administer panadol if necessary?* YesNo

    Parent's Name*

    Any further comments, information or special requirements, please let us know below. Let us know which horse your child rode last at Kiah!

    * An asterisk indicates a required field.


    This is the beginning of your child’s adventure!