Booking Forms | EQ Experience

Participant's full name

Participant's contact number

Provide Guardian's if participant is under the age of 18.

Participant's address

Provide Guardian's if participant is under the age of 18.

Participant's Age

How many times have you interacted with horses in the last 12 months?

Emergency contact name

Relationship to emergency contact

Emergency contact phone number

Are there any learning difficulties that need to be discussed, so the facilitator is able to accommodate accordingly?

If you selected allergies, please describe the allergy and reaction if applicable.

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

Year of last tetanus immunisation.

Is it necessary for you or your child to carry their own medication at all times?

Please provide name of medication/s, frequency and dosage.

I authorise the facilitator in charge to administer first aid and call an ambulance, if required. I agree to bear any cost thereby incurred.

I hereby apply to participate in EQExperience sessions on the terms and conditions as follows:

Horses have different temperaments and natures. All horses are potentially unpredictable, especially if frightened, hurt or mistreated.
The EQExperience facilitator will take all care possible and follow clear safety guidelines for the benefit of clients and horses.
The Client will be offered a 'safety guideline' by the facilitator which supports clients in being safe, aware and making safe choices in all session with horses.
The client agree not to deliberately frighten, hurt or mistreat the horses and to follow safety guidelines offered by the facilitator.
Certain risks are involved including but not limited to unforeseen collisions and accidents.
Knowing the potential inherent risks, the client accept that EQExperience and the Facilitators at EQExperience do not accept any liability for accident, damage or injury to the client/s or property.
EQExperience makes no warranty of any kind, expressed or implied, as to the nature, habits, and disposition of any horse involved in EQExperience sessions or activities.
All directions by the EQExperience facilitator must be observed.
Participants are responsible for wearing suitable clothing, long pants, and appropriate footwear, fully covered hard shoes or boots with flat heels.
EQExperience sessions do not offer mounted/riding sessions. All sessions will be conducted from the ground.
If participants do not comply with conditions set out in this application, or in the opinion of the EQExperience facilitator, engages in misconduct, discourteous or hazardous behaviour, then participation in the EQExperience session will cease and participation in future sessions will be reviewed or cancelled.
In the event of an accident of any kind, client/s must report this to the EQExperience facilitator immediately, or at the end of the session.
In the event of serious accident or injury where an ambulance or medical treatment is required, the client/s are responsible for any costs that may be incurred.

Signature

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Provide Guardian's if participant is under the age of 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 stated above.