Go Remarkable Program Application Form
For applicants under 18yo, this form must be completed by a parent / legal guardian. By submitting this form on behalf of an applicant under 18yo, you are accepting the terms of the program and the program waiver on their behalf.
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Email *
PROGRAM INFORMATION & GENERAL GUIDELINES

Sessions are all private sessions - just the student, the Mentor and the herd. This is not a group program.

No experience with or knowledge of horses is required. All activities are on the ground – no horse riding is involved.

Completing this form does not guarantee a place in the program. We are expecting the program to be over-subscribed and we will try to schedule more classes to accommodate everyone. We will be running the program 4 times a year and you will be prioritised for a place in future programs if not offered a place in this round.

A limited number of scholarships are available for those experiencing financial hardship. If you apply for a scholarship we will ask for some evidence of hardship. Currently receiving a Centrelink (or other Commonwealth) means-tested income support payment is sufficient evidence.

If you have NDIS funding, this program falls within the NDIS funding category of Innovative Community Participation.
Are you completing this form for yourself? *
Student's Name *
Your Name (if you are not the Student)
Contact Phone Number *
Student's Age *
Please tell us a little bit about you (or your child) and why you are seeking support through this type of program - no specific details are required, just an overview. This information is held in strict confidence - only the program coordinator and mentor have access to your answers. *
Are you confident that you can commit to the program for 8 sessions? *
Required
Do you/your child have any injuries or medical conditions that we need to be aware of? *
Required
If you answered Yes above, please provide some details. *
Do you need a scholarship to cover all or some of the program cost? *
Required
If needing a partial scholarship, how much are you able to contribute each week? *
RELEASE AND WAIVER OF LIABILITY
Because there are horses at the sanctuary that you may interact with during you visits, we ask that you sign the following waiver.
In consideration for being permitted to enter this property and participate in any way in horse activities, I, the undersigned acknowledge and accept that;• Horse activities can be dangerous and horses can act in sudden and unpredictable (changeable) ways, especially if frightened or hurt.• There is significant risk that serious injury or death may result from horse activities. I furthermore confirm I am aware of the obvious risks associated with activities involving horses and I knowingly and freely assume all such risks. I voluntarily participate at my own risk and assume sole responsibility for any injury, death or property damage I may suffer that arises from my participation in horse related activities.I understand and acknowledge the dangers associated with the consumption of alcohol or any mind altering drugs before and during the activity and take full responsibility for any injury, loss or damage associated with their consumption. I agree not to drink alcohol or take drugs prohibited by law before or during this activity.I agree to follow the directions given to me and that any misconduct or refusal by me to follow any direction can result in the CANCELLATION of participation in the activity and my immediate removal from the vicinity of any horse. I understand that any such non-compliance may result in injury, death and/or permanent disability and I agree to indemnify Kanyini Connections Ltd against all claims made by any person as a result of my failure to comply.I agree that I am solely responsible for my actions.I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS AND AGREE NOT TO Kanyini Connections Ltd, their volunteers, program facilitators, agents and/or employees, other participants, land owners, lessors of premises WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or LOSS OR DAMAGE TO PERSON OR PROPERTY.I agree that this waiver will apply immediately and will cover all future visits to the sanctuary. *
Required
A copy of your responses will be emailed to the address you provided.
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