‘Finley & District Horse & Pony Club Inc’ Membership Form (2015/ 2016)
Dear Parents/ Guardians,
Please find enclosed the Membership Forms and fees payable for joining both the ‘Finley & District Horse & Pony Club’ and the ‘Pony Club Association of Victoria’ (P.C.A.V.) There are two options for joining; 1. The Early Bird option (for those paying before the 30th of June, 2015 and; 2. the Normal fees option (after 30th of June) New membership cards are issued in July and are required for any competition, so the earlier the better. The PCAV fees contain a 24/7 insurance cover for the riders who are members, both at and away from Pony Club.
In both options the Finley & District Horse & Pony Club fee is only $35 paid once per family.
**Please make all cheques payable as detailed below and note that a ‘Working With Children’ check is now required before the membership will be accepted. I have included some information in regards to the new requirements with all adult volunteers, supporters, parents and instructors. The check is free for all volunteers and we need your W.W.C. number and the expiry date.
Firstly apply online and then take the printed form to the RTA to be processed. It isn’t too much of an arduous task, just an extra step that we have not had before. It is now required for the main person or persons that will be accompanying the child to Pony Club Rallies, but it is a good idea to get both parents ‘done’ as they may be present at different times.
Please fill out the forms and send them to Finley Pony Club, C/O PO Box 83, Finley NSW, 2713. They include the medical information, the Code of Conduct and the photo permission form, allowing your child’s picture to be taken at Rallies and competitions.
A. Early Bird Option (For fees paid before the 30th of June)
Finley & District Horse & Pony Club-‘ Family Membership Fee’ $35 per family
(Paid once per family)
PCAV Fee Component-
Early Bird Fees (if paid BEFORE 30th June.)
1.**Junior Rider (under 17 years as of the 1st of July, 2015) $125 ea
2.**Associate Rider (17 years as of the 1st of July, 2015- 25 yrs of age) $145ea
Total- ______
**Please make all Cheques payable to ‘Finley & District Horse & Pony Club Inc’
Send to PO Box 83, Finley, NSW, 2713.
B. Normal Fee Option (For Fees paid after 30th June and before 31st December, 2015)
Finley & District Horse & Pony Club-‘ Family Membership Fee’ $35 per family
(Paid once per family)
PCAV Fee Component-
1.**Junior Rider (under 17 years as of the 1st of July, 2015) $130 ea
2.**Associate Rider (17 years as of the 1st of July, 2015- 25 yrs of age) $150 ea
Total- ______
Purpose of the Changes- Working With Children Checks.
The intention of the Working With Children Check (WWCC) changes for Pony Club members is to provide a safe and secureenvironment for our riding members to enjoy Pony Club.
Steps to take to align with the changes ... Don't wait until 1st July 2015!
- Alter your membership forms to include:
- The WWCC information and identify the primary carer and who will be coming to the rally on a regular basis
- Advise new members after they have a “Come and Try” that their membership is conditional upon them
(after they have joined) upon production of the receipt that it has been applied for.
- Place a clause on your application form that membership is conditional upon the production of a WWCC.
- Advertise to your Adult Supporting Members and Adult Riding Members that they need to obtain a WWCC for
- Encourage your Adult Supporting members and Adult Riding Members to register for a WWCC, many may
youth orientated workplaces or volunteer organisations.
- Any member with a Teaching, Vic Police or other similar check should simply produce this check and need
- Adult Supporters and Adult Riding Members are considered volunteers at the Club and should apply under this area
- If a members already has a check simply ask them to add Pony Club Association of Victoria as a place of
See Cardholders on the Working with Children website
- If you have an Adult Member (Supporter) or Adult Riding Member who refuses to obtain a WWCC they must be refused membership and therefore may not attend Pony Club Rallys more than twice in a year without applying for a WWCC
‘Finley & District Horse & Pony
Club Inc’ Membership Form
(2015/ 2016)
SUMMARY PAGE - Membership Type: Junior Associate (17and over on 1st July)
Riding Member-Full Name:
Address:
Suburb/Town: / Postcode:
Phone Home: / Mobile:
Email:
Date of Birth: / Age: / Occupation:
Riding Experience: / Certificates gained: / Previous membership if any
Horse details: / Name:
Age:
Height: / Name:
Age:
Height:
Horse agisted:
Parent/Guardian: / Relationship:
Phone Home: / Work: / Mobile:
Email:
NSW Working With Children Check Details.
Parent/ Guardian that will be accompanying the Pony Club Member/s to Rally Days.NAME- / Working With Children Check Number- / Expiry Date-
Parent/ Guardian that will be accompanying the Pony Club Member/s to Rally Days.
NAME- / Working With Children Check Number- / Expiry Date-
Parent/ Guardian that will be accompanying the Pony Club Member/s to Rally Days
NAME- / Working With Children Check Number- / Expiry Date-
Parent/ Guardian that will be accompanying the Pony Club Member/s to Rally Days.
NAME- / Working With Children Check Number- / Expiry Date-
Member Declaration (Over 18 years)
I ______agree to;
abide by the rules, regulations, policies, procedures and directives, as stipulated by Pony Club Association of Victoria Competition rules and affiliated bodies. I acknowledge that horse sport is dangerous and that accidents causing death, bodily injury, disability and property damage can, and do happen. I acknowledge and agree that neither PCAV nor “the organizers” shall be under any liability for death, or bodily injury, loss or damage which may be sustained or incurred by the applicant, as a result of participation in or being present at PCAV endorsed events, except in regard to any rights I may have arising under the Trade Practices Act 1974. I acknowledge that I have read and understood the information provided in this membership form regarding codes of conduct and privacy.
Signed:...... Date:………………………………
Member’s Parent/Guardian’s Declaration - Must be signed for all members under the age of 18 years.
I/we consent to our above named child becoming a member of the Pony Club Association of Victoria as a member of the Finley Pony Club. I/we have read and accept the Member Declaration on behalf of our child.
Signed:...... Date:......
‘Finley & District Horse & Pony Club’ PCAV MEDICAL HISTORY & EMERGENCY CONTACTS FORM
The information you provide on this Medical History Form will be kept by your Pony Club in a secure place and used only in the event of an emergency. Keep in club – do not send to PCAV
Personal Details
First Name: ...... Last Name: ......
Sex: ...... Vehicle/Float Reg No.: ......
Date of Birth: ...... Age: ......
Emergency Contacts
Full Name...... Relation: ......
Phone (h)...... Phone (w): ......
Full Name...... Relation: ......
Phone (h)...... Phone (w): ......
Health Cover Details
Medicare No.: ......
Do you have Ambulance Cover? Yes NoAmbulance No.: ......
Do you have Private Health Cover? Yes NoFund: ......
GP & Dentist Details
Private Doctor: ...... Phone: ......
Address:……………………………………………………………………………. Suburb/Town: ……………………………
Private Dentist: ...... Phone: ......
Address:…………………………………………………………………………………………………………………………………………….
Suburb/Town: ……………………………………………..
Health History
......
I certify that the information given on this form is to be best of my knowledge a true account of my current physical condition.
Rider Name: ...... Signature: ...... Date: ......
Parent/Guardian: ...... Signature: ...... Date: ......
Medical Release
If emergency medical care is required for (name)...... and if permission is not available in a timely manner, then the undersigned authorised person appropriates emergency medical care, as deemed necessary by emergency medical personnel, a physician or the medical facility providing treatment.
Parent/Guardian: ...... Signature: ...... Date: ......
CODES OF CONDUCT
The Pony Club Association of Victoria’s Code of Conduct outlines behaviours that are expected of every person involved in our organisation, as well as identifying the types of behaviours that will not be tolerated.
It applies to members, officials, adult supporters, coaches, instructors, spectators, family, friends, administrators and other members of our diverse pony club community.
It applies to all PCAV, Zone and Club sanctioned activities.
The Pony Club Association of Victoria’s Code of Conduct supports everyone to have fun in a friendly and inclusive environment.
Pony Club Association of Victoria Inc. A13413S
Pony Club Association of Victoria Inc. A13413S
Our Values and Behaviours
Respect and recognition
- I treat others as I would like to be treated
- I treat everyone with dignity, courtesy and respect
- I appreciate performances by all participants
- I value and recognise good behaviours and the contribution of all
- I communicate openly and provide constructive supportive feedback
Caring
- The welfare of the horse is paramount
- I am considerate of others
- I encourage others to participate but I don’t force the issue
- I never resort to verbal abuse, harassing behaviour, hostility or aggression
Integrity
- I am open, honest and trustworthy
- I do what I say
- I am a Good Sport and encourage others to do the same
- I do not make any disparaging or belittling remarks about others
- I abide by the Code of Conduct
- Inclusion
- I support and help others
- I am flexible and responsive to people’s needs
- I work collaboratively to achieve the best outcomes
- I encourage the participation of all regardless of ability, age, gender, sexual orientation, race, culture or religion
- I contribute towards an enjoyable and safe environment for all.
Pony Club Association of Victoria Inc. A13413S
Our Values and Behaviours are central to the Pony Club Association of Victoria’s Code of Conduct. They ensure that we focus as much on HOW we do things as on WHAT we do by putting Values and Behaviours at the core of Pony Club participation.
I agree to abide to the ‘Codes of Conduct’
(signed Parent/ Adult Supporter) ______
(Signed Riding Member) ______
Club Members CODE OF CONDUCT I agree to………
Embrace and act in accordance with the Code of Conduct Role model and share your knowledge of this Code
Consider and uphold the welfare of the horse in any activity in which you participate
Raise situations that you think might be a breach of this Code with your Club or Zone’s officials. Encourage others to raise their concerns.
Officials, Parents, Guardians, Coaches, Instructors, Administrators, Observers and Supporters
Keep the Code of Conduct accessible for future reference
Embrace and act in accordance with the Code of Conduct Role model and share your knowledge of the Code
Lead by Example
Raise situations that you think might be a breach of this Code with your Club or Zone’s officials. Encourage others to raise their concerns
Encourage an environment where others can raise their concerns
Manage behaviour that is inconsistent with this Code
Getting Advice
Your Club’s officials are your most direct source of information and action.
Breaching the Code of Conduct
PCAV, Zones and Clubs treat breaches of this Code seriously.
If you breach this Code, or assist someone else to breach the Code, the breach will be investigated.
If it is determined that a breach has occurred, your Club, Zone or PCAV, as appropriate, will address the behaviour in line with the circumstances of the individual case. This could include coaching the people involved to assist them to recognise why the behaviours are inappropriate and Code of Conduct.
Pony Club Association of Victoria Inc. A13413S
PHOTO PERMISSION FORM.
I ______give my permission for my child/ children
______to have their photo taken whilst riding and participating in Pony Club Activities. I agree to allow my child/ children’s images to be used, at times, in our Club newsletter, newspaper articles, in publications and on the internet, etc, to promote the Finley & District Horse & Pony Club.
______signed (Parent/ guardian) if under 18 yrs.
Pony Club Association of Victoria Inc. A13413S
------
I ______give my permission to allow myself
to have my photo taken whilst riding and participating in Pony Club Activities. I agree to allow my images to be used, at times, in our Club newsletter, newspaper articles, in publications and on the internet, etc, to promote the Finley & District Horse & Pony Club.
______signed over 18 yrs.
**Please sign and return all forms, along with full payment to PO Box 83, Finley, NSW, 2713
WELCOME TO FINLEY PONY CLUB!!!
We are delighted to have you join our Club and hope you have a wonderful time with us!
Pony Club Association of Victoria Inc. A13413S
Pony Club Association of Victoria Inc. A13413S