2017 Equestrian Tasmanian Interschool Team Application
Nominations close June 15th to [email protected]
Athletes Details:
EA#
Surname:
Age:
First Name:
Date of Birth: ___/___/_______
Gender: M / F
Address:
Suburb:
State:
Postcode:
Have you previously competed at EA Interschool events: Yes / No If Yes – Competition Level:
If Yes: Please list event/s:
If No: Please supply a note from you EA NCAS coach confirming, you are training at the level you wish to compete:
Name of EA Coach:
How long have you been involved in equestrian sports?
Name of Club/s:
Are you interested in Joining our SuperSchool Education Programme? YES / NO / Already Joined
Students study the EA Introductory to Riding & Horse Management Courses (prerequisites for the Intro Coach Course).
Fee $60.00
Level 1 Riding and Horse Management Course (must have completed Introductory)
Fee $65.00
Parent or Guardian Details:
Surname:
First Name:
Relationship to Athlete:
Phone:
E-mail:
Does the above listed athlete have a Medical Condition?
a)
*which requires Medication Yes / No
b) *Other Disabilities / impairments Yes / No
*please note you will be required to provide medical documentation which outlines the diagnosis
School Information: NB You Must be attending the School/College Full time.
Name of School/College:
Sport coordinator Name (Imp):
YEAR:
Email:
Please Note: 1st Preference will be given to riders with Qualifying rounds at the IS Sport Championships followed
by the State Sport Championship.
Horse Details: (please provide separate sheet for each EA Registered horse)
Name of Horse:
EA #:
Bridle #:
Micro Chip #:
Please select the Sport in which you wish to represent Tasmania
DRESSAGE EVENTING JUMPING SHOW HORSE
Level of competition:
Secondary Dressage Grade: Preliminary/Novice/Elementary/Medium/Advanced/PrixStGeorge/Intermediate
Primary Dressage: Preliminary/Novice
Eventing Grade: EvA80/EvA95/EvA105/CNC1*
Secondary Combined Training: 60cmPrel1.3/80cmPrel1.3/95cmPrel1/3
Primary Combined Training: 45cmPrelim1.1/60cmPrelim1.1/80cmPrelim1.1
Secondary Jumping: 90cm/1.00m/1.10m/1.20m
Primary Jumping: 80cm/90cm
Show Horse: Show Horse/Show Hunter/Working Hunter
List your best performances on the above nominated horse at the following events:
Please Circle Sport: Dressage / Eventing / Show Horse / Jumping
2016/7 Events
State Championship
State InterSchool
Championship
ETas Regional
Championship
1 other EA event or EA
Ag Show
Grade/ Level
Total points Scored
Place
COMMENTS
Please Circle Sport: Dressage / Eventing / Show Horse / Jumping
2016/7 Events
Grade/ Level
Total points Scored
Place
COMMENTS
State Championship
State InterSchool
Championship
ETas Regional
Championship
1 other EA event or EA
Ag Show
Please Circle Sport: Dressage / Eventing / Show Horse / Jumping
2016/7 Events
State Eventing or
Jumping Championship
State Eventing or
Jumping IS
Championship
ETas Regional
Championship
1 other EA event
Grade/ Level
Total points Scored
Place
COMMENTS
The 2017 Australian Interschool Championships
At the Toowoomba Showgrounds, Toowoomba QLD from Monday
25thSeptember to Friday 29th September 2017.
Member Acknowledgement
I hereby apply for membership with Equestrian Australia Ltd & Equestrian Tasmania and agree to
abide by the rules and regulations of the EA and FEI and decisions of the Branch Committee.
In consideration for being permitted to participate in any way in horse sport activities, I, the
undersigned, understand, acknowledge and accept that:
Horse sports are a dangerous activity and horses can act in a sudden and unpredictable
(changeable) way, especially if frightened or hurt.
There is a significant risk that serious INJURY or DEATH may result from horse sport activities.
I understand and acknowledge the dangers associated with the consumption of alcohol or any
mind altering drugs and agree not to drink alcohol or take drugs prohibited by law before or during
any horse sports activities.
I agree to 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.
required under the relevant EA and FEI rules and regulations.
I have had sufficient opportunity to read this Dangerous Activity Acknowledgement and fully
understand its terms and sign it freely and voluntarily.
Dated: ______/______/_______ Signature of participant:
____________________________________
For Participants of Minority Age (Under Age 18)
This is to certify that I, as a parent/guardian with legal responsibility for this participant,
acknowledge, understand and accept ALL OF THE ABOVE and consent and agree to my minor child's
involvement or participation in horse sport activities. We are interested in our child representing
Tasmania at the 2016 EA Interschool Championships in Sydney. We understand this is a selffunded trip.
Signature of Parent/Guardian: _______________________________ Dated: ____/_____/____
PLEASE READ THE FOLLOWING DOCUMENTS:
IS Rules:
http://www.equestrian.org.au/sites/default/files/EA_National_Interschool_Rules_CLEANversion_0
1012017.pdf
Hot Weather Policy: http://www.equestrian.org.au/news/ea-policy-hot-weather-policy