Avondale Horse & Pony Club Incorporated

/ Avondale Horse & Pony Club Incorporated
Affiliated with The Pony Club Association of New South Wales Inc.
Club Grounds: Catherine Street St Ives NSW 2075
Mailing Address: PO Box 157, Avalon NSW 2107
Member Registration Form
PCANSW AFFILIATED MEMBERSHIP
This membership entitles you to full access of all club and PCANSW facilities, events, instruction, rally days, Closed, Open, Zone, Area and State pony club events, Regional Schools and Clinics.
Please complete the information required below:

Riders under 17 years are Junior Members and it is mandatory that at least one parent/guardian become affiliated with the PCANSW.
Riders 17 – 25 years are Associate Members and do not require a parent to be PCANSW affiliated.
Any Parent of a Junior and/or Associate member may become a Senior Member. Senior members 25 years of age, and over, are not permitted to ride for the purpose of receiving instruction or competing at Pony Club functions. They may be permitted to ride for the purpose of assisting, demonstrating or supervision with the approval of the Club Senior Instructor. Instructors or those applying to become Instructors, may, with the approval of the Club Senior Instructor, ride and receive instruction at instructional schools.
One Member Registration Form can be used per family.

Family name:
Rider 1 First Name / Circle: Junior / Associate / Date of Birth:
Horse name/s and Micro-Chip ID
Rider 2 First Name / Circle: Junior / Associate / Date of Birth:
Horse name/s and Micro-Chip ID
Rider 3 First Name / Circle: Junior / Associate / Date of Birth:
Horse name/s and Micro-Chip ID
PARENT DETAILS:
One PCANSW Affiliated Parent membership is Mandatory for Junior Members; Optional for Associate Members. Parent membership is a Senior Membership.
Parent 1 Full name:
Address:
Phone (mob pref): / Work:
Date of Birth: / Email:
Parent 2 Full Name (optional): /  Senior Parent Membership
 For information only
Contact phone: / Email:
Date of Birth:
ASSOCIATE MEMBERS EMERGENCY CONTACT ** required information
Contact full name: / Relationship:
Mobile number: / Alternative number:

PCANSW AFFILIATED MEMBERS MEDICAL AND HEALTH INFORMATION

RIDER: / Please note any rider medical or health condition we should be aware of:
HORSE: / Please note any horse medical or health condition we should be aware of:

ASSISTANCE LEVY **

Avondale Horse and Pony Club is run entirely by volunteers. As a condition of membership therefore, each family is required to play an active part in the organisation, maintenance and general functioning of the club, or alternately, to pay an Assistance Levy in lieu of nominating for a Committee Position and/or Club Role as specified in the “Club Committee and Volunteers Role Descriptions” document available to all members.
The Assistance Levy is payable by any family that does not nominate for a Committee or Volunteer Role below. It is applicable to all PCANSW riding members, associates, and non CA members (i.e. Grounds use members).
The Assistance Levy may also be applied within reason and at the discretion of the Club Executive, to any family whom the Executive determine are not, or have not, fulfilled their commitments in relation to assisting with the general maintenance, organisation and/or running of the club during the year.
Please carefully read, circle/complete either statement A or B below:
A: I/we understand that parent volunteers are responsible for the running of Avondale Pony Club and I/we agree to assist in order that my/our child/ren can enjoy the benefits of membership. As such I/we nominate to undertake the duties required in the role of and/or other tasks as required by the Club Executive from time to time.
B: In lieu of nominating for a Committee and/or Volunteer Role as stated above, I/we agree to pay the required Assistance Levy to Avondale Horse and Pony Club.

FEES AND SIGNATURES

Schedule of Fees / PCA Fees / Club Fees / Total / Amount Payable
1. PCANSW Affiliated Members
Junior Members U17yrs: 1st Child / $55 / $280 / $335
2nd Child / $55 / +$65 / $455
3rd Child / $55 / +$30 / $540
Associate Members: Riders 17 – under 25 years / $55 / $245 / $300
Families of 2 or more Junior and/or Associate riders may pay the 2nd / 3rd child membership fee above.
Parent (required for Juniors): Senior Member / $55 / Nil / $55
Additional Parent (optional) Senior Member / $55 / Nil / $55

Discount if joining after 1 July

/ -$130
Assistance Levy**(if appropriate; see above): / $150
Total Due:

Membership Registration FormPage 1 of 3

Read and

Initial

1. I confirm that any PCA affiliated riders above can walk, trot, canter and safely control their horse(s). The final assessment of this minimum skill requirement remains at the sole discretion of the Club Senior Instructor.

2. I understand that if my child is under the age of 17 I must arrange for a parent or adult guardian to be in attendance at all times at each Rally Day or other event (even if held at an alternative location).

3. I agree to provide the above riders with a suitable mount and all suitable gear for both horse and rider as necessary to enable them to participate safely in the riding services, activities and facilities provided by the Club.

4. I understand that if my child or their mount suffers from any medical conditions I must make these known to the Club Senior Instructor and Secretary prior to my first Rally Day.

5. I understand that any member (junior/child/family, associate or Non-PCA membership) using the grounds does so AT THEIR OWN RISK.

6. I agree to indemnify the Club and it’s Office Bearers in respect of any legal liability to the maximum extent permitted by law that the Club or Officer Bearers may have towards the riders which in any way arises from the rider’s use of the mount and/or gear provided by me and whilst the rider is participating in the horse riding services, activities and facilities provided by the Club.

7. Non-PCA members cannot ride on the grounds on Club Rally days without permission of the Senior Instructor.

8. By signing this form I understand and acknowledge that horse sports are dangerous activities and horses can act in sudden, unpredictable and changeable ways. I understand and acknowledge that serious injury or death may result from horse sport activities and hereby indemnify Avondale Horse & Pony Club Incorporated and it’s Officer Bearers from all liability to the greatest extent allowable by law in the event that either myself, children under my care or the care of their nominated guardian suffer injury or death.

/ 9. I agree that in the case of emergency the Club is authorised to have Medical and/or Ambulance Services called for the above applicants and that I will bear the full costs of any such services. /

10. I understand that parent volunteers are responsible for the running of Avondale Pony Club and as such I have either nominated for a Committee or Volunteer role OR agreed to pay the required Assistance Levy.

11. I understand that any person who is or has been a member of another Pony Club during the last 5 years wishing to join Avondale must obtain a transfer from their previous club and that transfer must accompany this Membership Application.

Rider’s Signature (if 18 years and over) Date:

If Rider under 18 years, I (full name) am over the age of eighteen years and am the parent or legal guardian of the rider/s named above.

In case of emergency, do you agree to have Medical and/or Ambulance Services called?YES/NO

Signature of Parent/Guardian: ______Date: ______

Membership Registration FormPage 1 of 3