Pegasus Expression of Interest Form
All information collected in this expression of interest form is completely cofidential and will not be shared or accessed outside of key Pegasus staff. Google Forms responses are stored in a worksheet that can only be accessed through a Google account login. For more information, please contact programs@pegasusact.com.au
Important information before applying
Pegasus , RDA coaches will review your expression of interest and if you do not have a condition that prevents you from participating we will place you on our waiting list we may also contact you to undertake an assessment.

When a vacancy arises, one Program Coordinator will contact you, and make you an offer for placement. We will provide you with a quote (Schedule of Supports), a Service Agreement, and all other forms and information.

There are some contraindications and conditions that may prevent you from participating. If you have any of the conditions listed below, riding may not be a suitable activity for you:

-Weight close too and in excess of 60kg for ambulant riders, and 32kg for participants requiring lifting. (this apply to riding program only).
-Severe behavioural disorders characterised by frequent aggressive episodes resulting in safety concerns to self or others
-Uncontrolled seizures – ie tonic clonic type occurring more than once a week.
-Extremely poor head control
-Excessive, chronic and/or recurring pain, especially as a result of physical activity
-Pathological fractures – ie osteogenisis imperfecta, severe osteoporosis
-Acute stage rheumatoid arthritis or juvenile rheumatoid arthritis
-Open pressure sores or wounds
-Unstable spine, including the following conditions, recent spinal injury and/or surgery, atlanto-axial dislocation, spondylolisthesis, acute disc herniation
-Spinal fusion with rod type internal fixation – ie Harrington or CD rods
-Severe fatigue related conditions – ie multiple sclerosis, muscular dystrophy ABI
-Severe clotting related blood disorders, ie haemophilia and/or medication/treatments which cause clotting related disorders such as heart conditions/chemotherapy.
-Degeneration/dislocation of the hip joint
Participant details
Participant full name *
Date of Birth *
MM
/
DD
/
YYYY
School (if applicable)
Height (cm) *
Weight (kg) *
Do you have an NDIS plan?
Clear selection
Do you have NDIS funding for Social and Community Participation included in your plan?
Clear selection
Participant diagnosis (please be specific): *
Disability Classification *
Required
If other, please provide details
Please note any Behavioural , medical or other conditions , and current medication *
Parent(s)/guardian name *
Address *
Phone 1 *
Phone 2 *
Email address *
Emergency contact name and details *
Programs
What programs are you interested in? *
Required
What days and times are you available?
Mobility
Is the participant able to walk independently? *
Do they use a wheelchair? *
If walking, do they have unstable/unsteady gait? *
Can they sit astride? *
Can they sit unsupported? *
Communication
Is the participant *
If non-verbal, please specify current methods of communication.
Can they follow instructions? *
Any notes or comments about communication?
Are they being treated by Allied health professionals ? Please Specify *
Other information
Is there any other relevant information that you would like us to be aware of? *
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