Please complete this enquiry form to request contact from the centre/s of your choice.

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 *

Please select RDA SA Centre/s suitable to your location. *

RDA Jennibrook Farm – Pine Road, Woodcroft 5163 SARDA Mount Gambier - Sunnybrae Rd, MOUNT GAMBIER 5290 SARDA Northern Area - Corner Ryans and Whites Roads, GLOBE DERBY PARK 5110 SARDA O’Halloran Hill - Majors Rd, O'HALLORAN HILL 5158 SARDA Oakbank - Shillabeer Road, OAKBANK 5243 SARDA Port Lincoln - Proper Bay Road, TULKA 5607 SARDA Port Pirie - Anzac Road, PORT PIRIE 5540 SARDA Southern Fleurieu – Lippizzaner Drive, VICTOR HARBOR 5211 SARDA Yorke Peninsula - Wallaroo Road, KADINA 5554 SA

What type of RDA program are you interested in? *

Mounted Program (Horse Riding)Unmounted ProgramCarriage DrivingSupported Volunteering

Age *

3-67-1213-1718+

Please select the participant weight range. This is needed to so we can provide you information about programs to suit you. Each of our centres has weight limit relative to the horses available. Some centres may not be able to accommodate riders over 80kg. Weight limits do not apply to unmounted programs. *

Please provide further details:

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

Note: Your preferred 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

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

Please describe other:

I have taken a moment to read the RDA SA Funding Information document *

I have read and understood the Privacy Collection Notice *

Today's date: *

I'm Not a Robot *

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