Participant expression of interest

Submitting this expression of interest places the participant on the waiting list to be considered for an RDAV program. It does not guarantee a place. RDAV will contact you about assessment and availability at a suitable Centre.

Your details: person completing this form

Your first name

Your last name

Your email address

Your phone number

Who you are completing this form for

Your relationship to the participant

ParticipantParent or guardianCarerSupport workerSchool representative

About the participant

Participant Name *

Date of Birth *

Suburb *

Postcode *

Participant weight (kg) *

Used to match the participant with a horse that can carry them safely.

Participant height (cm)

Preferences and support

Mobility

Disability or support needs

Physical / mobilityWheelchair userIntellectual disabilityAutism / neurodivergenceVision impairmentHearing impairmentNeurological conditionCommunication supportSocial / emotional / behavioural supportMultiple support needsOtherPrefer to discuss

Please describe the other disability or support needs

Consider Nearby Centres

YesNo

EOI Additional Information

Your preferences

First-choice Centre

Other Centres you would consider (up to two)

RDA WoolamaiRDA Bundoora ParkRDA CobramRDA HamiltonRDA MyrtlefordRDA PakenhamRDA Mornington Carriage DrivingRDA HorshamRDA BendigoRDA ColacRDA TerangRDA OaklandsRDA SeymourRDA WarragulRDA WarracknabealRDA DovetonRDA SheppartonRDA ViewbankRDA Swan HillRDA DaylesfordRDA PeninsulaRDA StawellRDA BairnsdaleRDA WarrnamboolRDA EchucaRDA St AndrewsRDA KnoxRDA MeltonRDA WarrandyteRDA BallaratRDA BarwonRDA MoorabbinRDA Maryborough

Days you can't come

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Tick any day the participant cannot come; leave them all clear if any day suits. Before answering, please check the operating days of your preferred Centre. Centres do not all operate on the same days.

I would like the RDAV newsletter

YesNo

I acknowledge that RDAV will use this information to assess and respond to this enquiry. *

Leave this empty

* required

Your answers save as you go

Privacy and how we handle your information · Accessibility

Riding for the Disabled Association of Victoria Inc, 400 Epsom Road, Flemington Victoria 3031.