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Regal Equestrian

Livery, Competition Training Centre and Riding School

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Adult Camp Information
Children & Teenagers Camp
Camp Application

 

 

 Application Form

 

 

Date of the Camp/Holiday Event you would like to come to:  __________________________________________________


 

 

Name…………………………………………………………………………………………………..

 

 

 

Telephone:  Home…………………….……………  Mobile…………………………..………

 

 

E-Mail……………………………………………………………………………………………………

 

 

Address………………………………………………………………………………….............................................................................

 

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Telephone:  Home……………………………..  Mobile………………………………………

Nex tof Kin / Emergency Contact 1………………………………………..................................................................................

 

 

 

Next of Kin / Emergency Contact 2………………………………………..................................................................................

 

 

Horse:           Name……………………………………Height …….……Age …………….

Riding experience (e.g. basic flatwork, works in outline, lateral work, likes to jump, jumps to what height, any hunting, nervous, confident etc)

 

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Horse/Pony experience

 

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Aims/Ambitions(Personal Goals, Competitions, Exams)

 

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Special Requests(Personal commitments, would like to be with X…etc)

 

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Signed______________________   Date  _____________

 

 

 

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MEDICAL FORM

 

 

Name:  __________________________________________________

 

 

DOB:  ___________________________________________________

 

 

Name/Address of next of Kin

Alternative Contact

 

 

 

 

 

 

 

Tel Day

 

Tel Mob

 

 

Tel Night

 

Email

 

 

 

Do you suffer from any of the following?  Please tick

 

 

Asthma

Diabetes

Allergies

Dyslexia

Epilepsy

Migraine

Hay fever

Dyspraxia

 

Any hearing or eyesight problems or disabilities?

 

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Any special dietary or other requirements?

 

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Any other medical or other condition of which staff should be aware?

 

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Religion (if applicable to medical treatment) _________________________________________________

 

Do you regularly take any form of medication – if so what? 

 

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In the event of an accident or any other condition requiring prompt medical or dental attention, and in the event that my next of kin cannot be contacted and I cannot be consulted, I give my permission for the organiser or her representative to assume responsibility for my well being.

 

Signed: _________________________________              Date: _________________