THAILAND PONY CLUB 

Please read and complete the application form IN CAPITALS and return to TPC 

 

NAME 

_____________________________________________________ 

DATE OF BIRTH 

_____________________________________________________ 

ADDRESS 

_____________________________________________________

_____________________________________________________

_____________________________________________________ 

TELEPHONE 

_____________________________________________________ 

 

EMAIL ADDRESS 

______________________________________________________ 

 

RIDING SCHOOL 

_____________________________________________________ 

 

FAX 

______________________________________________________ 

 

This section to be completed by parent/guardian 

 

FATHERS NAME 

______________________________________________________ 

 

MOTHERS NAME 

______________________________________________________ 

 

MOBILE _____________________________________________

 

MOBILE ______________________________________________

Please list ANY medical conditions TPC should be aware of with your child 

____________________________________________________________________________________________

 

DISCLAIMER 

I agree that the Thailand Pony Club (TPC) shall not be held responsible for any damage or injury that may be sustained by my child, named above, whilst participating in or being present at any activities organised by the TPC. I hereby undertake to indemnify you against any claims that may be instituted against you by reason of such damage or injury. I have read the aims of The Pony Club and I approve of my son/daughter becoming a member. I understand riding is a high risk sport and that in the event of an accident or incident involving my child, in my absence, I accept necessary emergency procedures may be organised on my behalf, for the safety of my child, of which I accept all costs incurred. 

TPC strongly recommends that parents ensure their child has sufficient medical insurance coverage 

FATHERS SIGNATURE 

__________________________________________________

MOTHERS SIGNATURE 

__________________________________________________ 

DATE DAY/MONTH/YEAR _______________________________

 

Thailand Pony Club Entrance Fee 2009 2000 baht (Includes Pony Club Official Badge and Tie) 

Annual Subscription Fee 500 baht 

TOTAL 2500 baht 

 

For office use