PONY CLUB AUSTRALIA NATIONAL CHAMPIONSHIPS 2011 RIDER INFORMATION PACKAGE PONY CLUB ASSOCIATION OF VICTORIA INC PROUDLY HOSTED BY

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1 PONY CLUB AUSTRALIA NATIONAL CHAMPIONSHIPS 2011 RIDER INFORMATION PACKAGE PROUDLY HOSTED BY PONY CLUB ASSOCIATION OF VICTORIA INC

2 Page 2 CONTENTS General Information... 3 National Mounted Games Information... 4 Mounted Games Team Flight Arrival Times... 6 Mounted Games Team Flight Departure Times... 7 Rider Contact & Emergency Details... 8 Medical Statement... 9 Rider Profile Horse identification Media/Publishing Consent Form Merchandise Order Form Official Dinner - Extra Tickets Order Form Checklist... 16

3 Page 3 GENERAL INFORMATION THE EVENT Will be conducted at Werribee Park National Equestrian Centre (WPNEC), K Road Werribee. Visit for further venue information All riders and Officials will have an evening meal provided by at WPNEC in indoor arena 1. Evening entertainment and activities will be provided each night to allow riders to socialize in a Team environment. There will be a variety of on-site food vans during the event for purchase of food for other meals. The township of Werribee is only 10 mins away and has many restaurants, several supermarkets and the usual family restaurant chains Werribee Pony club is running an ODE on the weekend of September 24 th & 25 th Riders competing at the PCA National Championships must not compete at this event under penalty of Elimination STABLING AND ACCOMMODATION AT WPNEC All bookings for stables and camping sites are to be made through WPNEC. Bookings will only be accepted on the event form contained in this pack. WPNEC Staff are experienced in running National Events and know that they need to locate States/Territories together. WELCOME DINNER The Official Dinner will take place on Thursday 29 th in Indoor arena 1. Tickets will be available for parents and supporters. Riders and Officials will have a ticket included in the cost of their entry. MERCHANDISE A Variety of items including polo shirts, caps, vests, thermo mugs, water bottles and rugby tops will be available to pre purchase. Further details will be forwarded as it comes to hand. PAYMENTS AND FORMS Please send all forms and make all payments to your State/Territory office

4 Page 4 NATIONAL MOUNTED GAMES INFORMATION ACCOMMODATION Team members, managers and coaches will be accommodated at the Lady Northcote Recreational Camp situated at Bacchus Marsh about 40 minutes North West of Melbourne. Accommodation is bunk house style with a range of onsite activities available. Lunch will be available on arrival on Thursday, breakfast each day, boxed lunch on Friday and lunch on Saturday. Dinner will be at National Equestrian Centre on Thursday (Official Dinner) and Friday and at Lady Northcote for those staying with us on Saturday evening. Please let us know of any specific dietary requirements. TRANSPORT Please bring your own sleeping bag. Pillows and a blanket will be provided. The teams will be transported from the airport by coach to the camp. We ask that teams endeavor to plan their arrival for late morning or early afternoon of Thursday 29 th September. NB: The Senior Teams conclude their stay on Saturday afternoon at the completion of the Junior Competition. Return transport for Senior Teams will be provided to Melbourne city or Tullamarine airport on Saturday evening 1st October in line with individual state requirements - exceptions by special arrangement. Return transport to Tullamarine Airport for the Junior Teams on Sunday morning 2nd October. UNIFORM Please bring your state saddle blankets. Uniform is in accordance with the International Mounted Games Exchange Rules January 2008 with the exception that State polo shirts and team jackets will be worn rather than shirts and ties. ITINERARY A daily itinerary will be provided on arrival at Lady Northcote. NB There will be no alternate tour activities. CLIMATE Melbourne can vary greatly at this time of the year. Please ensure that you bring warm clothing, wet weather gear and sunscreen.

5 Page 5 THE COMPETITION The Senior & Junior competition will be held on Saturday 1 st October. The senior competition will commence at 10am followed by the junior competition commencing not before 1.00pm. SET 1 SET 2 SET 3 SET 4 SET 5 SET 6 SET 7 Postman s Stepping Hi Lo Race Sword Stick Rope Race Hurdle Chase Stone Dash Race Pegging Race Ball & Bucket 5 Mug Race Ball & Cone 3 Mug Race Bottle Race Pony Express SPARE 1. Bending 2. Ball & Racquet Litter Race Windsor Castle TIE BREAKER Relay Mitavite Race (Spillers Pole) Pyramid Race Tyre Race Two Flag Decided by Coaches at Briefing Canadian Race Five Flag Coaches please note: NB: PCAV Bylaw 24.1 February 2010 Fall of Rider Should a rider fall, remount and complete the game or continue in the ride, they must be checked by the medical personnel responsible for the event and have a fall release form signed before taking further part in the competition.

6 Page 6 MOUNTED GAMES TEAM FLIGHT ARRIVAL TIMES FLIGHT ARRIVAL TIMES Junior Mounted Games Teams from (State) Will arrive at Melbourne Tullamarine Airport on Thursday 29 th September 2011 On Airline: Flight Number: At: am/pm Names of Passengers 1: 2: 3: 4: 5: Coach: Mobile Phone: Chaperone: Mobile Phone Senior Mounted Games Teams from (State) Will arrive at Melbourne Tullamarine Airport on Thursday 29 th September 2011 On Airline: Flight Number: At: am/pm Names of Passengers 1: 2: 3: 4: 5: Coach: Mobile Phone: Chaperone: Mobile Phone:

7 Page 7 MOUNTED GAMES TEAM FLIGHT DEPARTURE TIMES FLIGHT DEPARTURE TIMES Junior Mounted Games Teams from (State) Will depart from Melbourne Tullamarine Airport on On Airline: Flight Number: Day/Date At: am/pm Names of Passengers 1: 2: 3: 4: 5: Coach: Chaperone: Total Passengers Senior Mounted Games Teams from (State) Will depart from Melbourne Tullamarine Airport on On Airline: Flight Number: Day/Date At: am/pm Names of Passengers 1: 2: 3: 4: 5: Coach: Chaperone: Total Passengers

8 Page 8 RIDER CONTACT & EMERGENCY DETAILS The information provided on this form will be treated in accordance with the PCAV Privacy Policy. All information on the Rider Contact & Emergency Details and Medical Statement is confidential. Access to this form is limited to the Team Manager, Coach and Medical staff. RIDER PERSONAL DETAILS Full Name:... Pony Club:... State:... Address: Postcode:... DOB:... Age:... Height:... Weight:... Date C Certificate Achieved:... PRIVATE DOCTOR DETAILS Doctor s Name:... Emergency Contact No: (1)... (2)... HEALTH COVER & INSURANCE DETAILS Private Health Fund:... Private Health No:... Medicare No.:... Ambulance No.:... EMERGENCY CONTACT DETAILS Parent/Guardian Details Name of Parent/Guardian:... Relationship to Rider:... Emergency Contact No: (1)... (2)... Alternative Contact Details Alternative Contact Name:... Relationship to Rider:... Alternative Contact No: (1)... (2)...

9 Page 9 MEDICAL STATEMENT Do you suffer with any of the following complaints? (Please tick appropriate box) MEDICAL CONDITION YES NO MANAGEMENT PLAN* Allergic reactions (Anaphylaxis) Asthma Diabetes Eating problems Epilepsy Hay Fever Migraine Previous Injury Other (Please specify): * Please attach management plans if required for any medical conditions and ensure you brief the Team Manager and Coach on the management plan. INJURIES/CONDITIONS YES NO DETAILS Do you have any pre-existing injuries/conditions? Are you currently being treated for a pre-existing injury/condition? Do you have a current injury/condition? Are you currently being treated for a current injury/condition?

10 Page 10 MEDICATIONS Please list any current medications: Team members are not permitted to carry any prescribed medications that have not been notified to the team manager. The manager will carry an adequate First Aid kit. Team members are asked not to bring with them additional herbal preparations / pills / drops /lotions unless previously notified and discussed with the Team Manager. OTHER MEDICAL ISSUES Date of last tetanus injection:... SPECIAL DIETARY REQUIREMENTS EMERGENCY MANAGEMENT DECLARATION In the event of (rider name) requiring emergency medical or dental treatment whilst taking part in the National Championships, I hereby authorise the Team Manager (or in his/her absence the Coach) following consultation with a medical or dental practitioner, to allow emergency care to be given to myself/my child. This authority extends to all medical and dental treatment including the giving of an anesthetic where necessary. I will not hold the Pony Club Association of Victoria Inc, its Officers or team officials responsible for any accident or sickness suffered during the period of my/my child s team selection. Rider Name:... Signature:... Date:... Parent/Guardian (if rider is under 18):... Signature:... Date:...

11 Attach your photo here or us your picture to Page 11 RIDER PROFILE About You Full Name:... Pony Club:... State:... Age:... Years in Pony Club:... Favourite Food:... Favourite Movie:... Favourite Band:... Favourite Song:... Most admired sportsperson:... About Your Horse Horse s name:... Horse s Age:... Horse s colour:... About Your Team State:... Team:... Discipline:... About Your Pony Club Life Most memorable Pony Club moment:... Most exciting Pony Club achievement:... Your favourite thing about being a Pony Club member:... Other past times what do you like to do when you are not riding?... INFORMATION RELEASE AUTHORITY I understand the information I have provided on this form will be used in the program and may be used on electronic media. I give my permission for this information to be published in the Event Program, on the PCAV Website and in the PCAV Magazine. Signed:... Date:... Parent/Guardian (if under 18):... Date:...

12 Page 12 HORSE IDENTIFICATION Rider Details Full Name:... Date of birth:... Discipline:... Pony Club:... State:... Address:... Suburb/Town:... PostCode:... Phone:... Mobile: Horse Details Registered name or Petname (if not registered):... Sex: Mare / Gelding Microchip no.:... Age:... Breed:... Colour:... Markings:... Brands:... Address where horse is travelling to or from or PIC no.:...

13 Page 13 MEDIA/PUBLISHING CONSENT FORM For promotional purposes, photographs may be taken on the day of your competition, activity, event, meeting or workshop. To assist to promote, advertise or report on these activities photographs and results will be published from time to time on both print and electronic media. We ask that you give your permission for your pictures, name and results to be included in any promotional material. I... (Please print name) Give my permission Do not give my permission To be photographed/videoed by or media agents engaged by the during the event/activity I am participating in. I understand the images/film taken will remain the property of Pony Club Association of Victoria and/or the media agent engaged by and may be used to promote in both printed and/or electronic media. Parent/Guardian Signature:... Date:... Media Consent Form (under 18 years) For promotional purposes, photographs may be taken on the day of your competition, activity, event, meeting or workshop. To assist to promote, advertise or report on these activities photographs and results will be published from time to time on both print and electronic media. We ask that you give your permission for your pictures, name and results to be included in any promotional material. I... (Please print name)... on behalf of my child (child s name) Give my permission Do not give my permission To my child to be photographed/videoed by or media agents engaged by the during the event/activity my child is participating in. I understand the images/film taken will remain the property of Pony Club Association of Victoria and/or the media agent engaged by and may be used to promote in both printed and/or electronic media. Parent/Guardian Signature:... Date:...

14 Page 14 MERCHANDISE ORDER FORM Rider (Full Name):... Discipline:... Senior / Junior (circle) Address:... Suburb/Town:... PostCode:... Ph(1):... Ph(2): MERCHANDISE ORDER Merchandise Item Quantity Cost Total More details on merchandise available for pre purchase will be forwarded as soon as it becomes available

15 Page 15 OFFICIAL DINNER - EXTRA TICKETS ORDER FORM Rider (Full Name):... Discipline:... Senior / Junior (circle) Address:... Suburb/Town:... PostCode:... Ph(1):... Ph(2): GUEST LIST Name Total Extra Guests Total $70.00/ticket Dinner will be a three course meal concluding with a cheese platter tea and coffee Please make payment to your State/Territory Organisation.

16 Page 16 CHECKLIST Please make sure you have included the following items with your entry and forward them to your State/Territory Office payment to be made to your State/Territory Association Form Olympic Discipline National Mounted Games Rider Contact/ Emergency details Medical Statement Rider profile including photo Horse ID X Media Publishing Consent Merchandise Order Official Dinner Tickets Flight Arrival Form Flight Departure Form X X

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