Template 4 – Student Acknowledgement of Risk
Are you under 18 years of age?
Page 1 of 1
Yes / No
If yes, your Parent/Guardian is also required to confirm agreement to participate in horse
sport activities.
Full Name of Applicant:
Address:
Town/Suburb:
Post Code:
Date of Birth:
Participation in practical horse activities
I, the undersigned, understand, acknowledge and accept that:
1.
2.
3.
4.
5.
6.
7.
8.
9.
There is a significant risk that serious INJURY or DEATH may result from horse
accidents. The risk is increased if the horse is hurt or frightened
There is a risk that I may contract a zoonotic disease (e.g. Hendra) when working with
horses
I must wear protective clothing and equipment as determined by TAFE NSW staff, at all
times during horse-related practical activities
I must not drink alcohol or take drugs prohibited by law before or during any horse
activity
I must not carry or use a mobile phone or any other electronic device during any horse
activity unless prior authorisation is granted to ensure safety of the whole group
I must inform my teacher if I am taking medication or have any injury that may impair my
ability to safely participate in a horse activity
I must follow all directions of TAFE NSW staff. I understand that I will be removed from
the activity immediately, NO MATTER where that may occur and not permitted to return
if I fail to follow directions from a TAFE NSW staff member
Any failure to follow these rules increases the risk of injury, death or permanent disability
My enrolment will be cancelled if I fail to follow directions from a TAFE NSW staff
member.
I have read and understood this Acknowledgement of Risk form and agree to its conditions.
Name of Student:
Student Signature:
For participants of minority age (under age 18 years)
Date:
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.
Name of Parent/Guardian:
Parent/Guardian Signature:
(where applicable)
Date: