SIAM POLO PARK
APPLICATION FORM
Season 2006-2007
1. Personal Data
Full Name: __________________________ Years of playing Polo: _______
Home Address: ________________________________________________
_____________________________________________________________
Home Tel.: _______________________ Fax: ________________________
Mobile: ________________________ E-mail: ________________________
Passport Number: ___________________ Expiry Date: _____/_____/_____
Nationality: _______________________
Date of Birth: _____/_____/_____ Blood Group: _____________
Marital Status: ______________ Spouse Name: ______________________
Contact Number: ____________________
Business Address: _____________________________________________
____________________________________________________________
Tel.: __________________________ Fax: __________________________
Name of Secretary/Assistant: ____________________________________
Tel.: _________________________ Email: _________________________
Personal Doctor: __________________ Tel.: ________________________
2. Type of Membership (Please view pg.5 for full details):
¨ Full (B120,000.- Annual fee and B10,000.- Monthly Fee)
¨ Overseas (B50,000.- Annual Fee)
¨ Non-playing (B100,000.- Annual Fee)
¨ Guest (No Annual Fee)
3. I have signed the form of the waiver and I agree to abide by the rules and regulations of Siam Polo Park.
Members are advised that they must submit a “WRITTEN NOTICE” to the management team of Siam Polo Park one month before the unsubscribed date.
Signature of Applicant ______________________ Date _____/_____/_____
For Official Use Only |
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Membership No. |
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Received by: |
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Received Date: |
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Liability Waiver
I, _________________________________________,
acknowledge and understand:
I. that if I receive a lesson in any form of horse riding or engage in the sport of polo or any form of horse-riding whatsoever, I will do so entirely at my own risk and I agree that Siam Polo Park and its Management, Members, Guests, Visitors, and any riding instructor giving lessons at premises occupied by Siam Polo Park shall be exempt from all liability whatsoever and howsoever caused arising from the said tuition or my participation in the said sports (including all acts done incidental to the giving of performance of the tuition or sports).
II. that if I use all the facilities provided by the club of any kind, my attendance or presence at or about the premises of Siam Polo Park is entirely at my own risk.
In particular and without prejudice to the foregoing generally, I agree that Siam Polo Park, as well as its employees and agents shall be free and exempt from all liability, for I hereby waive all claims now or hereafter available to me in respect of any loss, damage, or injury upon me or upon any of my property or family.
Moreover, the same applies to any effect
whether caused or occasioned similarly by any default or negligence of the
Management of the Club or by any invitees, licensees, employees or agents of any
kind of Siam Polo Park and for whom Siam Polo Park may be responsible or arising
out of or connected with the state of any machines, buildings, apparatus or food
and drinks to be used or out of the state of the place at which the tuition or
sports is to be given or performed or the unsuitability or behavior of the horse
on which I ride or otherwise howsoever.
Signature: _______________________________
Printed Name: (______________________________) Date: _____/______/______
Membership and Chukka Fees
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Membership Type: |
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Honorary |
Full |
Overseas |
Non-Playing |
Guests |
Annual Fees: |
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B 120,000.- |
B 100,000.- |
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Monthly Fees: |
B 10,000.- |
B 10,000.- |
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*Horse Rental Monthly Fees: |
B 36,000.- |
B 36,000.- |
B 36,000.- |
B 72,000.- |
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Chukka Fees: |
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Use Own Horse(s)
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Free |
Free |
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Use Monthly Rented Horse |
Free |
Free |
Free |
Free |
Free |
Use Club Horse(s) |
B 2,000.- |
B 2,000.- |
B 3,000.- |
B 2,000.- |
B 4,000.- |
Use Other Member Horse(s) |
Free |
Free |
B 1,000.- |
B 1,000.- |
B 2,000.- |
No. Of Free Chukkas |
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12 |
24 |
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Stick & Ball Fees: |
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Use Own Horse(s) |
Free |
Free |
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Use Monthly Rented Horse |
Free |
Free |
Free |
Free |
Free |
Use Club Horse(s) |
B 2,000.- |
B 2,000.- |
B 3,000.- |
B 2,000.- |
B 4,000.- |
Use Other Member Horse(s) |
Free |
Free |
B 1,000.- |
B 1,000.- |
B 2,000.- |
Riding Fees: |
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Use Own Horse(s) |
Free |
Free |
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Use Club Horse(s) |
B 1,000.- |
B 1,000.- |
B 1,000.- |
B 1,000.- |
B 1,000.- |
Use Other Member Horse(s) |
Free |
B 1,000.- |
B 1,000.- |
B 1,000.- |
B 1,000.- |
**Note:
1. Only Honorary and Full members can rent stables for their horses.
2. Stable Fees:
· Baht 16,500.- per month for leasing the stable
· A discount of Baht 6,000.- will be offered to Non-dressage Horses, Injured/Sick Pony, or Baby Pony sharing the same stable of the parent
· For horses transferred during the month, they will be charged by the number of days the horses stay at the stable
· Baht 850.- per pony
· No charge for fixing shoes or hooves
4. Veterinary Fees:
· The actual cost of medicine and treatment
· Shared communal expenses (Averaged by the number of horses)
5. Horse Rental (Monthly basis):
· A player can select a pony to rent; however, Siam Polo Park possesses the pony ownership.
· A player can play up to 16 chukkas a month with the selected pony, but not more than one chukka per day.
· Stick and ball will be counted as a chukka and deducted from the 16 chukkas; therefore, using the same pony for a chukka and stick and ball will not be allowed on the same day.
· Overseas and Non-Playing players’ free 12 and 24 chukkas are not applicable to the 16 chukkas horse rental allowance.
· A player will be responsible for the actual horse’s veterinary costs during the time of rental and the following treatment if he/she injures the pony.
· A player can either pay Baht 5,000.- per month and cover all veterinary costs during the rental period and the following treatments caused by the player.
· The Polo Manager will decide on the pony to be rented based on its conditions.
· Acquiring a horse in Thailand costs approximately US$ 15,000.- including airfare, duty and fees.
· Members will receive a polo jersey for polo tournaments. The polo jersey will belong to the member, and in which will be charged for in the consecutive invoice.
7. Disciplinary Actions:
· The Polo Manager has the right to suspend any player with an aggressive way of play or may put the horse or other players at danger. Suspension could last from 10 days to a year.