Horse Safety Australia Box 209 Strathalbyn, 5255 Phone 08 8536 3274 Fax 08 8536 6115

INSTRUCTOR/TRAIL GUIDE RE-REGISTRATION

If it is three years or more since your last clinic, or your previous registration, you must meet the following requirements to retain currentHorse Safety Australia Registration / Membership.:.

Requirements for Re-Certification :

1.Active participation in teaching riding, conducting trail rides, and/or managing a site with a riding program. Documentation of this must be sent to the Horse Safety Australia office.

2.Continuing education in horsemanship and/or allied fields, which could include certificate/tertiary level courses, attendance at a horsemanship clinics or horse related conferences, local short courses etc. These do not have to be taught by a tertiary institution nor do they have to be for credit. Documentation of this must be sent to the Horse Safety Australia office (minimum 20 hours total since your last registration).

3.A current First Aid Certificate is needed to maintain current registration.

4.A signed Statutory Declaration that you comply with a number of basic requirements in running horse activities (documentation supplied)

DOCUMENTATION

In addition to the statutory declaration, and copy of your first aid certificate, documentation could include a written statement from a campsite/riding schoolmanager or employer, a completion of course certificate, a receipt or a letter of attendance from a course, statement of attainment from a TAFE, etc.

The Application for Renewal of Membershipcan be found on the back of this page. It shouldbe returned to the HORSE SAFETY AUSTRALIA office along with your three year membership fee of $198 (including GST)or one year fee of $66. You will be issued with a certificate with a new expiry date when approved. Cheques should be madeout toHorse Safety Australia .

APPLICATION FOR RENEWAL OF REGISTRATION

Application Date ......

Name...... Date of Birth ......

Address......

...... …...... Postcode......

Place of Certification...... …………...... Date of Certification ......

Level of Certification ......

Please tick and include documentation….

□Active participation in teaching riding, conduction trail rides and/or managing a school or camp with instructional group riding programme.

□Continuing education in horsemanship and/or allied fields : minimum 20 hours

□Senior (Level II) first aid (attach copy of your current certificate)

□Statutory Declaration on compliance with horse activity standards.

With this form please enclose:

  • Fees of $198 including GSTfor three years (or) fee of $66 for one more year’s registration
  • Documentaryproof of all the requirements listed above (see p.1)

Please send this form, cheque or money order, documentation, including a copy of yourcurrent First Aid Certificate and the Statutory Declaration to:Horse Safety Australia ,

Box 209,Strathalbyn, S.A., 5255. (Cheques to be made out to Horse Safety Australia please) Direct debit: Westpac Bank BSB 035 619 Account 11 1046. Please note your surname with your payment if using direct debit.

EXTENSIONS:

Should extra time be needed to complete your professional developemt, an extensioin of one year from the date of expiry of your registration period is permitted on payment of a fee of. $66. NB The Statutory Declaration and a current first aid certificate are still required for this. Please send a short letter explaining why you need an extension with your payment of $66.

Rev 410 ver 9