West Gippsland Zone Zone INC.

A0011083C

B”“K”and “ C Star” Clinic

Tooradin Estate, Tooradin

Sally Francis, Bev Shandley, KATE WILSON, NATALIE LEES and other specialist coaches

Wednesday 2 and Thursday 3rd October 2013

***OFFICIAL REGISTRATION FORM***

NAME OF MEMBER, AGE……………….

ADDRESS………………………………………………………………………………………………………………….

………………………………………………………….…………………………….POSTCODE………………………

Email:......

Phones ......

EFFIcency Standard(e.g. 1st year K, sitting Knext year, working towards C star1st year B...... ……………………………………

CLUB……………………………………………………………………………………………………………………….

D.C.’S NAME……………………………………………………..…..D.c.’s (…..)………………………………….

EmergEncy  (….)……………………………………………..……………..…………..(if parents unavailable)

AMBLUance subscriber yes no (delete inapplicable word)

Medicare No……………………………………………..

Please provide height……….…and age…….…..of your horse and if you need to be in a group with a friend

Instruction for West Gippsland Zone members / $130.00
Instruction for other Zone members / $150.00
Camp and food for 2 days Lunch, dinner, breakfast and lunch / $65.00
total enclosed / $......

………….…….…….………………….………….…………….………….………

RETURN ABOVE SECTION

CLOSING DATE FOR REGISTRATIONS 20th September, 2013

  • Please bring notebook, pen, log books and worksheets. PONY CLUB UNIFORM MUST BE WORN.
  • Please advise of any relevant information regarding medical history.
  • Members will be advised of acceptance by email.
  • Gear check before riding in each session
  • Horses must be at least 4 years old, no stallions, colts or rigs.
  • Neither the organising committee of this competition nor the PCAV accepts any responsibility whatsoever for any accident, damage, injury or illness to horses, riders, ground spectators or any other person or property.
  • The organising committee reserves the right to cancel any class; divide any class; alter times; refuse any entry with or without stating the reason.
  • Entering this clinic constitutes acknowledgement that PCAV rules apply and acceptance of these rules.
  • No refunds after closing date except with Vet ormedical Certificate.
  • Dogs are prohibited without exception
  • Lungeing at this clinic must take place in the confined area designated exclusively for lungeing, by the organizing committee.
  • Camping available on grounds with shower and toilets available. Meals to be prepared at fee of $65 for 2 days.

Payment by Direct Deposit- BSB 633 108 Acc No. 1425 59962 Bendigo Bank west Gippsland Zone. Mail entries to: Mrs Jenny O’Sullivan , 1720 Buffalo-WaratahRoad, Tarwin Lower, 3956.

K (and others if interested in sessions) certificate riders

Section A: Nominate three activities you think you might complete as part of certificate. numbering your preferences

Activity: Section A / Preferences
Showjumping
Cross Country
Ride at a given pace
Stockwork
Dressage
Tent pegging/ Mounted games

Section B

Activity: / Preferences
Knots
Clipping:
Truck and float maintenance
SJ Course design
CC Course design
Lungeing:
Shoeing

Section c

Activity: / Preferences
Track work
Mare and Foal care
Showing
Breaking in
Endurance

Are there any particular things you would like to get out of this clinic?

ALL ENQUIRIES TO:Mrs Jenny O’Sullivan  56632386 or 0419153377