2017 PONY/JUNIOR DRESSAGE HIGH PERFORMANCE PROGRAMME APPLICATION

Please complete and return to Susann Killilea, by the 24th October 2016. 
skillilea@horsesportirleand.ie

PLEASE USE BLOCK CAPITALS

SURNAME	FORENAME	DATE OF BIRTH	

ADDRESS 	

 	POSTCODE 	

CONTACT DETAILS

HOME_

MOBILE

EMAIL 	

EMERGENCY CONTACT

_MOBILE

I would like the following Pony/Ponies/Horse/Horses to be considered for the Pony/Junior HP Programme

PONY NAME/HORSE NAME	DI POINTS	AGE	GENDER	HEIGHT	
1.					
2.					

PONY NAME/HORSE NAME	LEVEL OF DRESSAGE CURRENTLY COMPETING AT/ FEI QUALIFICATIONS /(IF APPLICABLE)	
1.		
2.		

NAME OF COACH/COACHES

DRESSAGE 	

TEL. NO 	

NAME OF VET & PRACTICE

NAME_ 	

TEL. NO_ 	

COMMUNICATION

I wish for HSI to use group text messaging relating to the participation of my son/daughter in relation to HSI activities. I wish for such texts messages to be sent to:

Myself only	Text contact number:

My child and myself	Text contact numbers:	1. 2.