Please complete this enquiry form

Name of individual completing form *

Relationship to participant (e.g. self, parent, support coordinator etc.)

Email Address *

Phone *

Participant details

Participant First Name *

Participant Last Name (optional at the initial enquiry stage)

Participant Age *

Please select an RDA SA Centre that is suitable to your location.

RDA Southern Fleurieu – 15 Lippizzaner Drive, VICTOR HARBOR 5211 SARDA Yorke Peninsula - Wallaroo Road, KADINA 5554 SARDA Mount Gambier - Sunnybrae Rd, MOUNT GAMBIER 5290 SARDA Northern Area - Corner Ryans and Whites Roads, GLOBE DERBY PARK 5110 SARDA O’Halloran Hill - 3A Majors Rd, O'HALLORAN HILL 5158 SARDA Oakbank - Shillabeer Road, OAKBANK 5243 SARDA Port Lincoln - 426 Proper Bay Road, TULKA 5607 SARDA Port Pirie - Anzac Road, PORT PIRIE 5540 SA

Please select an RDA NT Centre that is suitable to your location.

RDA in the Top End - 3710 Catalina Road, MARLOWS LAGOON 830 NTRDA Alice Springs - Lot 5687 Blatherskite Park, ILLPARPA 873 NT

Please select an RDA WA Centre that is suitable to your location.

RDA BrookValley Farm - 1225 Railway Parade, BULLSBROOK 6084 WARDA Brigadoon - 303 Cathedral Avenue, BRIGADOON 6069 WARDA Murray Mandurah - Fairbridge Road, PINJARRA 6208 WARDA Oakford - 88 Gossage Rd, CARDUP 6122 WARDA South West - 746 Bussell Highway, DALYELLUP 6230 WARDA Capricorn - 1441 Old Yanchep Road, PINJAR 6077 WARDA Carine - 77 Monyash Road, CARINE 6020 WARDA Harvey - Weir Road, HARVEY 6220 WA

Australian Capital Territory Centre

RDA Australian Capital Territory - 119 Drake Brockman Dr, HOLT 2615 ACT

Tasmanian Centre

RDA South - 500 Kalang Avenue, GLENORCHY 7010 TAS

New South Wales Centre

RDA Deniliquin - Smart Street, DENILIQUIN 2710 NSWOther RDA NSW Locations (All other NSW locations are not affiliated with RDA Australia. Your enquiry will be sent to RDA NSW).

What type of RDA program are you interested in?

Mounted Program (Horse Riding)Unmounted program

What days and times are you available to participate in a program?

Note: Your nominated RDA Centre may not operate or offer participant programs 7 days a week.

Monday

MorningAfternoon

Tuesday

MorningAfternoon

Wednesday

MorningAfternoon

Thursday

MorningAfternoon

Friday

MorningAfternoon

Saturday

MorningAfternoon

Sunday

MorningAfternoon

I have read and understood the Privacy Collection Notice *

Is there anything else that you would like us to know at this intial enquiry stage?

Please describe 'other' *

I'm Not a Robot *

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