Membership Renewal

Membership Renewal Form 2019

Fill in the online form or print out and send in the form from the forms page.

* Indicates required field

I am an existing member, renewing my membership for 2019 *

Yes

Name *

First

Last

Address *

Mobile *

Other phone *

Email *

My EWA (or other EA Branch) membership number is (You do not have to be a member of an EA branch to be a member of SRDI) *

Type of membership *

Next of kin contact details (this person may be called in a case of illness or injury at one of our events). Name and Phone Number *

For minors
(if the member is under 18 as at 1 January 2019, the parent or legal guardian must complete this part of the form)
This is to certify that I, as a parent/guardian with legal responsibility for this member, acknowledge,
understand and accept ALL OF THE INFORMATION presented in this document and consent and agree to my
minor child’s involvement or participation in horse sport activities.

Name of minor *

First

Last

Date of birth of minor *

Parent/Guardian Phone Number *

Name of parent/guardian *

First

Last

Date *

Member dangerous activity acknowledgement

In consideration of being permitted to participate in any way in horse sport activities, I, the undersigned,
understand, acknowledge and accept that:
1. Horse sports are dangerous activities and horses can act in a sudden and unpredictable (changeable) way,
especially if frightened or hurt.
2. There is a significant risk that serious INJURY or DEATH may result from horse sport activities.
3. There are dangers associated with the consumption of alcohol or drugs, and agree not to drink alcohol or take
drugs before or during any SRDI horse sport activities.
4. I must follow the directions of any event organiser or official and that any misconduct or refusal by me to
follow any direction of any organiser or official can result in the CANCELLATION of my participation in the
activities and my immediate removal from my horse NO MATTER where that may occur.
5. I must wear an approved helmet at all times whilst participating in the sport where this is required under the
relevant EA rules and regulations.
6. I have had sufficient opportunity to read this Dangerous Activity Acknowledgement and fully understand its
terms and sign it freely and voluntarily.

Waiver (please read carefully before accepting)

1. I hereby agree to all rules and the conditions stated in relation to the Dangerous Activity Acknowledgement
and understand that neither the owners of venues used for activities, nor Swan River Dressage Inc will be
held liable for any injuries or illness that may occur in relation to Swan River Dressage Inc events.
2. I have read and agree to abide by the Policies and Documents to be found on the Equestrian Australia
website equestrian.org.au
3. I acknowledge and understand that Swan River Dressage Inc's public liability insurance states that all riders
must wear a current approved hard hat or helmet and EA approved riding boots.
4. I acknowledge and understand that neither the owners of venues used for activities, Swan River Dressage
Inc, its organising committee, members or any other person acting on behalf of the Swan River Dressage Inc
accept liability for any loss, death, accident or injury to horse, participants, spectators or any person or
property whatsoever.
5. I hereby agree that in the event of storm, rain, wind or other adverse weather or bio-security conditions,
the organisers of the event have the right to modify or cancel the event. Their decision will be final.
6. I acknowledge that I have sole responsibility for my personal possessions and equipment during the event
and related activities.
7. I hereby attest and verify that I ‘am sufficiently fit and have sufficiently trained for this event/competition’.
8. I hereby consent to receive medical or veterinary treatment for me and/or horse/s, which may be deemed
advisable by those present in the event of injury, accident and/or illness during the event.
9. I consent to photographs/film of me (or minors I am responsible for) undertaking SDRI equestrian activities
being used by SRDI as SRDI’s promotional material AND/OR being used by SRDI’s official sponsors as
promotional material for their businesses.

By checking this box, you have read and understood the WAIVER and the MEMBER DANGEROUS ACTIVITY ACKNOWLEDGEMENT document above for yourself or on behalf of the minor *

I agree

Payment details - please pay your annual membership fee by bank funds transfer now.
Bank details: Account name: Swan River Dressage Inc BSB: 066115 Account no: 10634524 Ref: (your name)

Submit