|
Breed Society
|
|
|
Membership Number
|
|
|
Photography / Image Use Consent
|
|
|
I am aware that there are time that photography and/or video footage maybe taken during club activities by approved agents and/or officers of the society. Such images/video shall only be used for society purposes in accordance with the Safeguard and Protection U18’s Policy and I give consent for myself (son/daughter) to feature in such photo/images. I hereby only grant approved agents the right to use the images resulting from the photo/video.
|
|
|
This includes any reproductions of the images for all general purposes ie. Local newspapers, local magazines, other community promotional articles (inc. flyers) and the Clubs website.
|
|
|
I do or do not consent to photography/image use
*
|
|
|
Veterinary Emergency
|
|
|
In the unlikely event of an accident where your horse is severely injured and in need of emergency attention, the Magnetic Coast Western Performance Horse Club strongly recommends you provide your consent to calling veterinary assistance. Note that you will be responsible for all costs incurred. Declaration: In the event of an accident, where I am injured and unable to do so, I hereby give my authorization for an authorised representative of the Magnetic Coast Western Performance Horse Club
|
|
|
I hereby give my authorization for an authorised representative of the Magnetic Coast Western Performance Horse Club to call for veterinary assistance in the event that the horse is severely injured and in need of emergency attention.
*
|
|
|
Medical Information
|
|
|
The club is an active participant in horse sport activities and accidents causing death, bodily injury and disability can, and do occur. In any case of emergency and as part of the society’s responsibility to its membership.
|
|
|
Participants Name:
*
|
|
|
Next of Kin
*
|
|
|
Relationship
*
|
|
|
Mobile #
*
|
|
|
Home #
*
|
|
|
Doctor
*
|
|
|
Medical Centre
*
|
|
|
Phone
*
|
|
|
As far as you are aware, are you allergic to any drugs/foods?
*
|
|
|
Are you taking any regular medication?
*
|
|
|
Do you have any long term illnesses? (eg epilepsy, asthma, diabetes)
*
|
|