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Age Group:
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18-30yrs:
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31-40yrs:
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41-50yrs:
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51 & over:
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Emergency Contact Information:
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Next of kin incase of emergency, Name:*
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Next of kin incase of emergency, Number:*
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Medical Information:
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Allergies or conditions that may need on-site medical assistance::
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Please provide details of any allergies or medical conditions:
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Medication usually located (eg. glove box, tack locker – vehicle/float description)::
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Describe location of any emergency medication:
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Do you hold a current First Aid Certificate?:*
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Would you like to be a named first aider within the club?:*
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If yes, please send or attach a copy of your certificate:
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PARC Rallies:
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PARC Members are required to help out at least ONE rally a year. Please tick what type of rally you would be interested in helping with.:
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Dressage:
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Showing:
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Show Jumping:
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Trekking:
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Eventing:
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Other::
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Would you be interested in mid-week rallies?:*
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Comments & Suggestions: Comments or suggestions you would like to contribute to the club? (Event sponsorship, land you have permission for shared riding, favourite public places toride, social gatherings, other areas of interest – mounted games, western, orienteering etc.):
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Please share your ideas and suggestions:
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