PERTH HORSE & PONY CLUB

Jon Sanders Drive,

OSBORNE PARK WA 6017

PH&PC’s 60th year!!

Diamond Series Hacking & Dressage

SUNDAY 9th June 2019

Cash Purse to the Series winners!!

Prizes for all champions!!

Come along and help us celebrate!!

Gates open 7.30am Starts 9.30am Measuring 7.30 – 10.30

Canteen available Trade Stalls welcome

Enquiries: Melanie Bray: 0405 643 389 or Sue McKay: 0408 097 783 secretaryphpcinc@gmail.com

CONDITIONS OF ENTRY

1. No Hay is permitted outside of horse floats or trucks – Council Regulation

2. The committee of Perth Horse and Pony Club Inc. (PH&PC) reserve the right to cancel, alter or combine any event/s they may deem necessary on the day

3. All competitors must be a member of either EWA, SHC or Perth Horse and Pony Club for insurance purposes to compete / ride on the grounds

4. The grounds are public open space and cannot be sealed from the public access. All entrants must sign the declaration when picking up numbers or they will NOT be allowed to compete

5. All persons on horseback are required to wear a recognised standards approved helmet and boots as a condition of entry. (Please note new helmet standards apply as of Jan 2017, it is rider responsibility to ensure your helmet complies for insurance purposes)

6. The judge’s decision is final. Protests must be received in writing within 30 minutes of the conclusion of the event in question, with a $100 fee attached – refund will only take place if the protest is upheld

7. Riding on the grounds is not permitted if you are not entered, unless you pay an insurance levy and sign a disclaimer

8. The PH&PC reserves the right to cancel/modify the event, without prior notice, as they see fit and to interpret all rules & make a decision where any dispute arises

9. Please take all Rubbish and Manure with you. Rubbish bags are available from the Nominations Office –Council Regulation

10. Current Show Horse Council of WA or EWA height certificates must be presented when nominating for either the official or unofficial rings

11. Ponies or horses/rider combinations that have competed in the Official ring in the past 36 months, cannot compete in the unofficial rings. Green/novice horse & official rider or official pony/horse & inexperienced novice rider is acceptable. Snaffle bridles must be worn in Walk/Trot classes

12. Horses/Ponies may only compete in Show Horse OR Show Hunter (Official Rings)

13. Official competitors are to be aware that this club is affiliated with SHC/EWA & RAS, it is your responsibility to ensure you meet their individual requirements in regard to gaining points. In the Official Hack ring you may only use points from the ladies, gents or child’s class, not all 3. The winner of the child’s class in official is entitled to compete in the champion class

14. Rider’s age will be their current age on the day of event (proof of age may be requested for rider and child’s classes)

15. Stallions are NOT permitted in the hack rings. Tractable stallions may be ridden in dressage. Competitors must abide by the EA Stallion Safe Practice Policy and green discs must be displayed

16. Under NO circumstance is approaching the judge, judging or coaching from the side of the ring permitted. Failure to abide by these rules will lead to immediate disqualification and forfeit of entry fees

17. Maximum of 2 dressage tests per rider & horse combination either same level or 1 level higher and riders must ride at the level either they or their horses’ are eligible for. Horses and/or riders deemed to be competing at an unsuitable level by the organizing committee may not have their entries accepted

18. In the event that two dressage tests are ridden at the same level, only the first test ridden will be counted towards any placings. A horse/pony may only be ridden by one rider

19. Dressage rules as per EA Australia, but specific show rules or PH&PC related rules take precedence

20. Plaiting and appropriate attire is required

21. Boots, bandages and bell boots may be worn during warm up but must be removed before being gear checked and entering your dressage test

22. The Dressage draw will be available on PH&PC Facebook page and emailed to all competitors before the event

23. All Dressage competitors must pay the helper fee and complete a duty (or provide a helper) to be refunded the helper fee

24. The organizing committee of the Perth Horse and Pony Club Inc., judges, officials, DO NOT accept liability for any accident, loss, damage, illness or injury to horses, owners, riders, and spectators or any other person or property whatsoever. Entry to the grounds is at your own risk and the ‘Waiver of Liability’ form must be signed by all entrants prior to participation; this is a condition of our insurance

Diamond Series Hacking Rules

Although competition is open to all riders, only Perth Horse & Pony Club members are eligible to gain points towards the Diamond Series

(Membership is available at $25. This can be paid and submitted with entry or completed on the day)

1. Riders must be a PH&PC financial member

2. Points will only be awarded to Horse & Rider combinations

3. Competitors must compete in at least 2 of the 3 series days to be eligible

for points (ALL competitors are eligible to compete for prizes on the day)

4. Qualifying classes are Height, Weight, Ladies/Girls or Gents/Boys in Hacking

5. Points will be awarded up to 6th place (see table below)

6. Series winner will be the highest points accumulated in each category over the 3 shows

7. In the event of a tie the highest points in height classes will take precedence. If this does not break the tie the highest points in Ladies/Girls & Gents/Boys will apply

8. Presentation of series prizes will be after all classes are completed on day 3 of the series

9. Competitors must be present to receive awards (If winner is not present to receive award it will be forfeited to the runner up. Third place will then become runner up)

Purse Cash Prize Categories

Official Hack Ring Official Pony Ring Unofficial Ring

Show Hack

Hunter Hack

Show Pony

Hunter Pony

Leading Rein

Walk/Trot/ Canter

Walk/Trot

Winner Winner Winner Winner Winner Winner Winner

$200 $200 $200 $200 $200 $200 $100

Runner Up

Runner Up

Runner Up

Runner Up

Runner Up

Runner Up

Runner Up

$50 $50 $50 $50 $50 $50 $30

To 1st Place To 2nd Place To 3rd Place To 4th Place

To 5th Place

To 6th Place

1st - 6 Points 1st – 6 Points 1st – 6 Points 1st – 6 Points 1st – 6 Points 1st – 6 Points

2nd – 5 Points 2nd – 5 Points 2nd – 5 Points 2nd – 5 Points 2nd – 5 Points

3rd – 4 Points 3rd – 4 Points 3rd – 4 Points 3rd – 4 Points

4th – 3 Points 4th – 3 Points 4th – 3 Points

5th – 2 Points 5th – 2 Points

6th – 1 Point

Official Hack Ring Ring 1 Judge: Start: 9.30am

1 Show Galloway over 14h up to & including 14.2h 2 Show Galloway over 14.2hh up to & including 15hh 3 Show Hack over 15hh up to & including 15.2hh 4 Show Hack over 15.2hh up to & including 16hh 5 Show Hack over 16hh 6 Lightweight Show Galloway over 14hh up to & including 15hh 7 Medium/Heavyweight Show Galloway over 14hh up to & including 15hh 8 Lightweight Show Hack over 15hh 9 Medium/Heavyweight Show Hack over 15hh 10 Ladies/Girls Show Galloway over 14hh up to & including 15hh 11 Ladies/Girls Show Hack over 15hh 12 Gents/Boys Show Galloway over 14hh up to & including 15hh 13 Gents/Boys Show Hack over 15hh 14 Childs Show Galloway over 14hh up to & including 15hh (rider 17yrs & under) 15 Childs Show Hack over 15hh (rider 17yrs & under) CHAMPION SHOW GALLOWAY Reserve Champion Show Galloway

CHAMPION SHOW HACK Reserve Champion Show Hack

16 Rider 18 years - 20 years 17 Rider 21 years – 30 years 18 Rider 31 years & over

CHAMPION SENIOR RIDER Reserve Champion Senior Rider

19 Show Hunter Galloway over 14h up to & including 14.2h 20 Show Hunter Galloway over 14.2hh up to & including 15hh 21 Show Hunter Hack over 15hh up to & including 15.2hh 22 Show Hunter Hack over 15.2hh up to & including 16hh 23 Show Hunter Hack over 16hh 24 Light/Mediumweight Show Hunter Galloway over 14hh up to & including 15hh 25 Heavyweight Show Hunter Galloway over 14hh up to & including 15hh 26 Light/Mediumweight Show Hunter Hack over 15hh 27 Heavyweight Show Hunter Hack over 15hh 28 Ladies/Girls Show Hunter Galloway over 14hh up to & including 15hh 29 Ladies/Girls Show Hunter Hack over 15hh 30 Gents/Boys Show Hunter Galloway over 14hh up to & including 15hh 31 Gents/Boys Show Hunter Hack over 15hh 32 Childs Show Hunter Galloway over 14hh up to & including 15hh 33 Childs Show Hunter Hack over 15hh

CHAMPION SHOW HUNTER GALLOWAY Reserve Champion Show Hunter Galloway

CHAMPION SHOW HUNTER HACK Reserve Champion Show Hunter Hack

Official competitors please be aware that this club is affiliated with SHC, EA and the RAS. It is your responsibility to ensure that you meet their individual requirements with regard to gaining points

Official Pony Ring Ring 2 Judge: Start 9.30am

1 Leading Rein Smartest on Parade 2 Leading Rein Rider 7yrs & under 3 Leading Rein Show Pony 11.2hh & under 4 Leading Rein Show Pony over 11.2h up to & including 12hh 5 Leading Rein Hunter Pony 11.2hh & under 6 Leading Rein Hunter Pony over 11.2h up to & including 12hh

CHAMPION LEADING REIN PONY Reserve Champion Leading Rein Pony

7 First Ridden Smartest on Parade 8 First Ridden Rider 7yrs & under 9 First Ridden Show Pony 11.2hh & under 10 First Ridden Show Pony over 11.2h up to & inc 12hh 11 First Ridden Hunter Pony 11.2hh & under 12 First Ridden Hunter Pony over 11.2h up to & inc 12hh

CHAMPION FIRST RIDDEN PONY Reserve Champion First Ridden Pony 13 Show Pony Hack 12hh & under 14 Show Pony Hack over 12hh up to & including 12.2hh 15 Show Pony Hack over 12.2hh up to & including 13hh 16 Show Pony Hack over 13hh up to & including 13.2hh 17 Show Pony Hack over 13.2hh up to & including 14hh 18 Lightweight Show Pony 12.2hh & under 19 Medium/Heavyweight Show Pony 12.2hh & under 20 Lightweight Show Pony Hack over 12.2hh up to & including 14hh 21 Medium/Heavyweight Show Pony Hack over 12.2hh up to & including 14hh 22 Girls/Ladies Show Pony 12.2hh & under 23 Girls/Ladies Show Pony Hack over 12.2hh up to & including 14hh 24 Boys/Gents Show Pony 12.2hh & under 25 Boys/Gents Show Pony over 12.2hh up to & including 14hh 26 Childs Show Pony 12.2hh & under 27 Childs Show Pony Hack over 12.2hh up to & including 14h

CHAMPION SMALL SHOW PONY HACK CHAMPION LARGE SHOW PONY HACK Reserve Champion Small Show Pony Hack Reserve Champion Large Show Pony Hack 28 Junior Rider 11 years & under 29 Junior Rider 12,13 & 14 years 30 Junior Rider 15,16 & 17 years CHAMPION JUNIOR RIDER 17 YEARS & UNDER Reserve Champion Junior Rider 17 Years & under 31 Show Hunter Pony Hack 12hh & under 32 Show Hunter Pony Hack over 12hh up to & including 12.2hh 33 Show Hunter Pony Hack over 12.2hh up to & including 13hh 34 Show Hunter Pony Hack over 13hh up to & including 13.2hh 35 Show Hunter Pony Hack over 13.2hh up to & including 14hh 36 Light/Medium Show Hunter Pony 12.2hh & under 37 Heavyweight Show Hunter Pony 12.2hh & under 38 Light/Medium Show Hunter Pony Hack over 12.2hh up to & including 14hh 39 Heavyweight Show Hunter Pony Hack over 12.2hh up to & including 14hh 40 Girls/Ladies Show Hunter Pony 12.2hh & under 41 Girls/Ladies Show Hunter Pony Hack over 12.2hh up to & including 14hh 42 Boys/Gents Show Hunter Pony 12.2hh & under 43 Boys/Gents Show Hunter Pony over 12.2hh up to & including 14hh 44 Childs Show Hunter Pony 12.2hh & under (rider 17 years & under) 45 Childs Show Hunter Pony Hack over 12.2hh up to & inc 14hh (rider 17 years & under) CHAMPION SMALL SHOW HUNTER PONY CHAMPION LARGE SHOW HUNTER PONY Reserve Champion Small Show Hunter Pony Reserve Champ Large Show Hunter Pony

Unofficial Walk/Trot Ring Ring 3 Judge: Start: 9.30am LEADING REIN CLASSES 1 Leading Rein Smartest on Parade 2 Leading Rein Rider 8yrs & under 3 Leading Rein Rider 9yrs – 12 years 4 Leading Rein Pony 12.2hh and under 5 Leading Rein Pony over 12.2hh up to and including 14hh 6 Girls Leading Rein Pony 12.2hh and under 7 Girls Leading Rein Pony over 12.2hh up to and including 14hh 8 Boys Leading Rein Pony 14hh and under

CHAMPION LEADING REIN PONY Reserve Champion Leading Rein Pony

WALK/TROT CLASSES

9 Best Presented Walk/Trot 14h & under 10 Best Presented Walk/Trot over 14h 11 W/T Rider 10 years & under 12 W/T Rider 11 years to 13 years 13 W/T Rider 14 years to 17 years

CHAMPION WALK/TROT JUNIOR RIDER Reserve Champion Walk/Trot Junior Rider 14 W/T Rider 18 years to 25 years 15 W/T Rider 26 years & over

CHAMPION WALK/TROT SENIOR RIDER Reserve Champion Walk/Trot Senior Rider

16 Walk/Trot Pony Hack 14hh & under 17 Walk/Trot Galloway Hack over 14hh up to & including 15hh 18 Walk/Trot Hack over 15hh 19 Walk/Trot Lightweight Pony 14hh & under 20 Walk/Trot Medium/Heavyweight Pony 14hh & under 21 Walk/Trot Lightweight Galloway over 14hh up to & including 15hh 22 Walk/Trot Medium/Heavyweight Galloway over 14hh up to & including 15hh 23 Walk/Trot Lightweight Hack over 15hh 24 Walk/Trot Medium/Heavyweight Hack over 15hh 25 Walk/Trot Girls/Ladies Pony 14hh & under 26 Walk/Trot Girls/Ladies Galloway over 14hh up to & including 15hh 27 Walk/Trot Girls/Ladies Hack over 15hh 28 Walk/Trot Boys/Gents Hack (any height) 29 Walk/Trot Encourage the Canter 14hh & under 30 Walk/Trot Encourage the Canter over 14hh

CHAMPION WALK/TROT PONY 14H & UNDER Reserve Champion Walk/Trot Pony 14h & under CHAMPION WALK/TROT GALLOWAY Reserve Champion Walk/Trot Galloway CHAMPION WALK/TROT HACK Reserve Champion Walk/Trot Hack

Unofficial Open Ring Ring 4 Judge: Start: 9.30am 1 Best Presented 14h & under 2 Best Presented over 14h 3 Rider 11 years & under 4 Rider 12, 13 & 14 years 5 Rider 15, 16 & 17 years

CHAMPION UNOFFICIAL JUNIOR RIDER Reserve Champion Unofficial Junior Rider 6 Rider 18 years to 25 years 7 Rider 26 years & over

CHAMPION UNOFFICIAL SENIOR RIDER Reserve Champion Unofficial Senior Rider 8 Pony 12.2hh and under 9 Pony over 12.2hh up to & including 14hh 10 Galloway over 14hh up to & including 15hh 11 Hack over 15hh up to & including 16hh 12 Hack over 16hh 13 Lightweight Pony 12.2hh & under 14 Medium/Heavyweight Pony 12.2hh & under 15 Lightweight Pony over 12.2h up to & including 14h 16 Medium/Heavyweight Pony over 12.2h up to & including 14h 17 Lightweight Galloway over 14hh up to & including 15hh 18 Medium/Heavyweight Galloway over 14hh up to & including 15hh 19 Lightweight Hack over 15hh 20 Medium/Heavyweight Hack over 15hh 21 Girls/Ladies Pony 14hh & under 22 Boys/Gents Pony 14hh & under 23 Girls/Ladies Galloway over 14hh up to & including 15hh 24 Girls/Ladies Hack over 15hh 25 Boys/Gents Hack over 14hh 26 Show Hunter Pony up to & including 14hh 27 Show Hunter Galloway over 14hh up to & including 15hh 28 Show Hunter Hack over 15hh

CHAMPION UNOFFICIAL PONY HACK Reserve Champion Unofficial Pony Hack

CHAMPION UNOFFICIAL GALLOWAY HACK Reserve Champion Unofficial Galloway Hack

CHAMPION UNOFFICIAL HACK Reserve Champion Unofficial Hack

Diamond Series Dressage Rules

Although competition is open to all riders, only Perth Horse & Pony Club members are eligible to gain points towards the Diamond Series (Membership is available at $25. This can be paid and submitted with entry)

1. Riders must be a PH&PC member 2. Points will be awarded to Horse & Rider combinations 3. Competitors must compete in at least 2 of the 3 series days to be

eligible for points. (ALL competitors are eligible to compete for prizes on the day)

4. Dressage points will be awarded for combinations in 2 consecutive levels only. E.g. Prep/Prelim, Prelim/Novice etc.

5. Points will be awarded up to 6th place (see table below) 6. Series winner will be the highest points gained in each category

over the 3 shows (see below) 7. In the event of a tie the combination with the highest test

percentage will break the tie 8. Presentation of series prizes will be after all classes are completed on day 3 of the series 9. Competitors must be present to receive awards (If winner is not present to receive award it will be forfeited to the

runner up. Third place will then become runner up)

Purse Cash Prize Categories

Dressage Junior Dressage Senior/Open

Prep Preliminary Novice Prep Prelim/Novice

Elementary/ Medium

Winner Winner Winner Winner Winner Winner

$100 $200 $200 $100 $200 $200

Runner Up Runner Up Runner Up

Runner Up Runner Up Runner Up

$50 $50 $50 $50 $50 $50

To 1st Place To 2nd Place To 3rd Place To 4th Place

To 5th Place

To 6th Place

1st - 6 Points 1st – 6 Points 1st – 6 Points 1st – 6 Points 1st – 6 Points 1st – 6 Points

2nd – 5 Points 2nd – 5 Points 2nd – 5 Points 2nd – 5 Points 2nd – 5 Points

3rd – 4 Points 3rd – 4 Points 3rd – 4 Points 3rd – 4 Points

4th – 3 Points 4th – 3 Points 4th – 3 Points

5th – 2 Points 5th – 2 Points

6th – 1 Point

DRESSAGE TESTS June 9th will be the “A” Tests October 13th will be the “B” Tests November 17th will be the “C” Tests

Classes will be Junior Prep, Senior Prep, Junior Prelim, Senior Prelim, Junior Novice,

Senior Novice, Open Elementary and Open Medium Dressage will be pre entry only!!

Please email your dressage entry form to dressagephpcinc@gmail.com along with proof of payment.

2019 DIAMOND SERIES

ENTRY FORM

**If competing in BOTH hacking and dressage, mark which tests you will ride and pay day fee

Please complete one form per horse

EXHIBITOR

Armband

Breastplate

ADDRESS

CONTACT NUMBER

EMAIL

PH&PC NUMBER

SHCWA NUMBER

EWA NUMBER

HORSES NAME

HORSES HEIGHT

Sighted Office Use

RIDER’S NAME (IF DIFFERENT TO EXHIBITOR)

DATE OF BIRTH If under 18

______/______/______

Please tick which ring you will be competing in:-

Show Horse Show Hunter Unofficial Leading Rein

Please tick which tests you will ride:-

Prep Prelim Novice Elementary Medium

DRESSAGE ENTRIES CLOSE – THURSDAY 6TH JUNE

FEES PERTH H & P CLUB MEMBERS NON-MEMBERS

Hacking $40.00 $60.00

Leading Rein Fee $35.00 $50.00

Dressage (per test) $20.00 $30.00

Day Fee per horse (Hacking & 2 dressage tests) $60.00 $90.00

Armband Deposit $ 5.00 $ 5.00

Ground Fee N/A $10.00 $10.00

EA Levy (only payable by EA members) $ 7.00 $ 7.00

Dressage Helper Fee (compulsory) $25.00 $25.00

Membership ($25 or $50 family)

(If joining with entry please complete as a member) Total Total

Hacking may be pre entered OR enter on the day - email completed entry form and proof of payment (copy of deposit receipt must be included) dressagephpcinc@gmail.com

Bank Deposit – NAB – PERTH HORSE & PONY CLUB INC. BSB:- 086-488 Account No:- 508293537 Reference DS & your Surname

IF YOU ARE NOT A MEMBER OF PERTH HORSE AND PONY CLUB THE DISCLAIMER STATEMENT MUST BE SIGNED

DRESSAGE HELPER DUTY ** This page must be included with entries

All riders must pay the $25 helper fee. This will be refunded by Direct Deposit after you have been seen

to have done your helper duty. Report to office once duty is complete.

MINIMUM AMOUNT OF TIME REQUIRED BETWEEN TESTS IF RIDING 2 TESTS? (Tick box)

15 – 30 Minutes

30 – 60 Minutes 60 + Minutes

Helper duties and test times will be allocated to allow you to complete both.

Email completed dressage/day fee entry form and proof of payment

(copy of deposit receipt must be included)

Email to dressagephpcinc@gmail.com

Bank Deposit – NAB – PERTH HORSE & PONY CLUB INC. BSB:- 086-488 Account No:- 508293537 Reference DS & your Surname

HELPER DUTY

Helper Name Mobile Number

Helper Email Bank details for helper

duty fee refund

Must be completed or

will not be refunded!

Account Name: ______________________ Bsb: ______________________ Acc:

Duty:

Setup dressage arena (approx. 8.30am)

Setup hacking arenas (takes approx. 20 mins)

Dressage arena pack up at end of show

Hacking arena pack up at end of show

Dressage runner

Dressage penciller Hacking penciller (4)

Dressage marshall/gear checker

Perth Horse & Pony Club Inc. Jon Sanders Drive, Osborne Park WA 6017

Disclaimer Statement I,................................................., ACKNOWLEDGE AND AGREE AS A CONDITION OF PARTICIPATING that either the Perth Horse & Pony Club Inc., nor its agents, officials, volunteers, medical personnel, nor any persons, promoters, sponsors, advertisers, owners and lessees of premises used to conduct the EVENT shall be under any liability for my death or any bodily injury, loss or damage which may be sustained or incurred by me, as a result of participation in or being present at the EVENT, except in regard to any rights I may have arising under the Trade Practices Act 1974. I acknowledge that equestrian activities are dangerous and that accidents

causing death, bodily injury, disability and property damage can, and do happen.

In the event of an outbreak of Equine Influenza and subsequent lockdown

I,………………………………., am responsible for the care and wellbeing of my

horses/ponies. I agree to comply with the DPI regulations and am responsible

for any costs incurred.

BY SIGNING HEREUNDER I CONFIRM HAVING READ AND UNDERSTOOD THE

CONTENTS OF THIS DISCLAIMER.

SIGNATURE..................................................................................................

DATE..........................................

If participant is UNDER 18 years, PARENT or GUARDIAN MUST SIGN this disclaimer.

THE PERTH HORSE & PONY CLUB INC.

2019 RIDING MEMBERSHIP APPLICATION

SURNAME: FIRST NAME/S

ADDRESS:

RIDING MEMBERSHIP $25.00

Please list any ALLERGIES OR DISABILITIES:- (Name of member and details)

EMERGENCY CONTACT:

In the event of an emergency, if the Parent/Guardian can not be contacted quickly, please nominate

another person who could be contacted.

NAME OF CONTACT: ______________________________________________________

TELEPHONE: ____________________________

In consideration of the PERTH HORSE AND PONY CLUB Inc (hereinafter called "The Club") accepting my child/myself as a member (hereinafter

called "The Member") and enrolling the member and keeping the member enrolled, I, the undersigned agree to the member attending and

participating in all club activities and agree to and do indemnify the club, its officers, instructors and helpers are not entitled to be indemnified

under a policy of insurance whatsoever from and against any damages, compensation claims of demands arising out of any accident, injury,

disease or illness which may befall or occur to the member during the members participation in any club activity or function connected with the

club or when travelling to or from such activity or function. I further authorise any officers, instructors and helpers of the club in the event of

such accident, injury, disease or illness to obtain the necessary medical assistance or treatment and for this purpose engage any medical,

ambulance and nursing assistance and/or hospital treatment and in this event, I agree to pay all such fees and expenses, these said fees to be

paid to the club on demand.

I hereby agree to my child/myself applying for membership of the Perth Horse & Pony Club Inc. and I/WE

agree to abide by their rules and regulations, and indemity as listed above.

SIGNATURE: _______________________________DATE:____________________

NAME (Please Print): __________________________________________________

Office Use

Receipt No.

Member No.

Ref - Surname

or email to - secretaryphpcinc@gmail.com

Send to: The Treasurer Direct Deposit:-

C/- 30 Townshend Road BSB; 086-488

SUBIACO WA 6008 A/C: 508293537

members are ineligible to vote at Annual General Meetings.

Date of Birth (if under 18)

SUBURB: POSTCODE:

EMAIL ADDRESS: PHONE:

MEMBERSHIP RATES: PH&PC Riding Membership entitles the rider to receive members nomination

rates at PH&PC events, and riding members will accumulate points towards annual awards. Junior

THE PERTH HORSE & PONY CLUB INC.

2019 FAMILY MEMBERSHIP APPLICATION

SURNAME:

(Name you would like correspondence sent to eg SMITH FAMILY)

ADDRESS:

RIDERS NAMES: Date of Birth: HORSE/PONY NAMES:

NON-RIDER NAME:

FAMILY MEMBERSHIP $50.00

(Up to 3 Riders plus 1 Non Rider)

Please list any ALLERGIES OR DISABILITIES:- (Name of member and details)

EMERGENCY CONTACT:

In the event of an emergency, if the Parent/Guardian can not be contacted quickly, please nominate

another person who could be contacted.

NAME OF CONTACT: ______________________________________________________

TELEPHONE: ____________________________

In consideration of the PERTH HORSE AND PONY CLUB Inc (hereinafter called "The Club") accepting my child/myself as a member (hereinafter

called "The Member") and enrolling the member and keeping the member enrolled, I, the undersigned agree to the member attending and

participating in all club activities and agree to and do indemnify the club, its officers, instructors and helpers are not entitled to be indemnified

under a policy of insurance whatsoever from and against any damages, compensation claims of demands arising out of any accident, injury,

disease or illness which may befall or occur to the member during the members participation in any club activity or function connected with the

club or when travelling to or from such activity or function. I further authorise any officers, instructors and helpers of the club in the event of

such accident, injury, disease or illness to obtain the necessary medical assistance or treatment and for this purpose engage any medical,

ambulance and nursing assistance and/or hospital treatment and in this event, I agree to pay all such fees and expenses, these said fees to be

paid to the club on demand.

I hereby agree to my child/myself applying for membership of the Perth Horse & Pony Club Inc. and I/WE agree to abide by their rules and regulations, and indemity as listed above.

SIGNATURE: _______________________________DATE:____________________

NAME (Please Print): __________________________________________________

Office UseReceipt No.Member No.Or email to - secretaryphpcinc@gmail.com

MEMBERSHIP RATES: PH&PC Family Membership entitles the famiy to receive members nomination

rates at PH&PC events, and riding members will accumulate points towards annual awards. To be

eligible to vote, family membership must have a person over 18 years as their guardian/proxy.

POSTCODE:

PHONE:EMAIL ADDRESS:

SUBURB:

Send to: The Treasurer, C/- 30 Townshend Rd, SUBIACO WA 6008 Direct Deposit:- BSB; 086-488 A/C 508293537 Ref:- Surname