North Star Pony Club
The camp will be held at the North Star Sporting Club from the Monday the 5th of July until Friday the 9th of July. The camp will commence at 8.30am every morning and will finish after the last class at approximately 4.30pm each day. All horses are to be at the club for a Gear Check by 8.00 am on the 5th July 2021 with a mounted start by 8.15am. More details & general information have been emailed to you alongside these forms.
Rider Name*
First Name Last Name
Riders date of birth *
Year Month Day
Date
Riders Age At Camp*
Age
Contact Email*
example@example.com
Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Phone Number
Has the rider attended North Star Pony Camp before?*
YES NO
If Yes - what troop were they in?
Please outline the riders horse riding experience briefly and any information that would help with troop allocation for 2021.
What is the horses name
Please note: Children attend the North Star Pony Camp or any organised activity on the condition that,
1. They do so at their own risk.
2. The North Star Pony Club, committee officers, attendants and those in charge are absolved from all Liability in respect of any injury, sickness or other loss or damage however caused.
3. The parents will indemnify the club, committee, officers, attendants and those in charge against any claim or proceeding on behalf of the child.
4. I am willing for my child/ren on this form to attend the North Star Pony Club camp from Monday 5th ---Friday 9th July 2021.
I have read the conditions and rules of the camp & agree to abide by them.
I have read the conditions and rules of the camp & agree to abide by them.*
Clear
Medical information
Doctors Name
Doctors address / Practice name
Medicare Number
Enter number followed by the childs reference 1234567899 / 3
Private Health Provider & Number
Preferred Hospital
Ambulance cover
YES NO
Any injuries in past 12 Months
Allergies
Does the child have Asthma - If yes please email asthma plan
YES NO
Tetanus - date of last injection
Do you give permission for the first aid officer to give paracetamol if required?
YES NO
If the child is taking any medications please provide details
Please indicate if either parent has medical or nursing experience
The North Star Pony Club Inc. will not be held responsible for any injury caused by any person doing their duty to the best of their ability. I hereby give permission for my child to be transported to hospital under supervision, and that further treatment be allowed by permission of person in charge of child until the parents arrive.*
PARENT / GUARDIAN Clear
For those with one child attending you must continue to fill out the entire form.
For those with multiple children attending - You MUST do child info and medical information at each child then do duty details and payment details on just one child’s form, so leave the rest of the other child’s forms blank from here (Emergency contact details, duty details are all the same for each child). So basically one form in entirety and then can leave those double up bits out. Welcome to do all forms in entirety but you will see double ups.
& Put all children’s payment information on one form.
Emergency Contact Information
Camp will commence at 8.30am every morning and will finish after the last class at approximately 4.30pm each day. A parent or guardian is to be on the grounds at all times for children on horses. We understand at times that a parent will need to duck home or vacate the grounds for short periods of time. Please ensure you let Robyn or Sandy know if you are leaving the grounds and have your mobile phone with you incase you needed to be contacted in the case of an emergency.
Duty Details
The success of North Star Pony Camp is dependant on parents assistance. In the interest of the childrens safety and smooth running of the camp we ask parents to perform a mothers and fathers duty. Please provide your preference for which day suits you below.
Mothers Duty Day Preference
Monday Tuesday Wednesday Thursday Friday Unable to do Duty $100
Fathers Duty Day Preference
Monday Tuesday Wednesday Thursday Friday Unable to do duty $100
Working With Children Check (NSW) or Blue Card Details (QLD)
People who work with children are required under state legislation to have a Working With Childrens Check (WWCC) Number (NSW) or a Blue Card (QLD).
All sporting clubs are required to record WWCC / Blue Card numbers - the links to apply for WWCC have been emailed previously as is it also a madatory for affliation as an Adult NSW Pony Club member to hold a WWCC/Blue card (at least one parent must hold this). If you have a number already please provide details below - otherwise please apply and submit the information before camp.
Volunteer / Parent Name
First Name Last Name
Persons Date of Birth
Year Month Day
Date
WWCC or Blue Card Number
WWCC or Blue Card Expiry Date
Year Month Day
Date
Camp Fees
Have you already paid pony club affiliation fees for 2021?
YES NO
If the rider is affiliated with another club please indicate which club the rider is affiliated with
2019 CAMP FEES
These include hay costs for one horse - additional horses will have a $40/horse levy apply.

FIRST 2 CHILDREN
ADDITIONAL CHILDREN
NSPC MEMBERS
$235.00
$215.00
OTHER PONY CLUB MEMBERS
$265.00
$245.00
(Camp fees includes the $5 zone fee this year - it was too confusing last year when seperate)
AFFILLIATION FEES
NSW Pony club require all children to have at least ONE Adult member per family to be registered as a non or riding member. Current membership of a pony club is ESSENTIAL for insurance purposes and unless affiliation fees have been paid your child will not be able to attend camp. This is now done online through my pony club and paid via credit card.
RIDING
$75.00
NON RIDING
$40.00
SECOND NON RIDER
$20.00

Please pay the applicable camp fees into the following bank account.
North Star Pony Club Inc
BSB: 064 415 (Commonwealth bank)
Account: 10023927
Reference: Rider / Family name

Please email the payment receipt to this
email - northstarponyclub@gmail.com
Please indicate the total fees for rider/s that you will transfer to the North Star Bank Account.
Payment breakdown information
Should be Empty:

North Star Pony Club

Medical information

Emergency Contact Information

Duty Details

Working With Children Check (NSW) or Blue Card Details (QLD)

Camp Fees