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Alkira Adina Equestrian

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WildQuest at Alkira Adina Equestrian

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Manage My Lessons

For pre booked lesson payments, please click here.

NDIS Participant Intake Form

Please fill out this form at your own pace. If you have any questions along the way, don’t hesitate to reach out. We look forward to meeting you and learning more about you.

Participant's First name*

Last name*

Parent/ Caregiver name

Email*

Phone*

Birthday*

Day

Month

Year

Address*

NDIS number*

E-mail to send invoice to*

Please choose the code you would like to use*

Core: Assistance with Social, Economic and Community Participation: Access community social and rec activities 04_104_0125_6_1

Core: Assistance with social, economic and community participation: Community, social and recreational activities 04_210_0125_6_1

Capacity building: Increased social and community participation: Innovative Community Participation 09_008_0116_6_3

Capacity building: Increased social and community participation: Skills development and training 09_009_0117_6_3

Capacity building: Increased social and community participation: Community participation activities 09_011_0125_6_3

Capacity building: Improved Relationships: Individual social skills development 11_024_0117_7_3

Capacity Building: Improved Daily Living: Skills development and training: 15_037_0117_1_3

Single choice*

Self managed

Plan managed

NDIA managed (Innovative Community Participation only)

Can you tell us a little about your disability so we can best prepare the lesson (eg, anxiety, deaf, ASD)*

This just helps us prepare to support you in the best way possible.

Participant's horse experience*

Participant's weight and height (max 85kg). Please note, Equine Assisted Learning Programs begin on the ground and may include riding in future lessons. *

Upload NDIS plan or a copy of participant's goals (Review INCLUDED in your session cost)

Where any document is uploaded for review, this will be treated as non-face-to-face support time, charged in a minimum 15-minute increment.

I acknowledge that while Alkira Adina Equestrian offers a range of services, including allied health services, it is not a Riding for the Disabled program. Participants must be able to physically engage in activities independently, without the need for hands-on physical support from staff.

I have read, understood and acknowledge the Terms and Conditions (Service Agreement)

I have read, understand and acknowledge Alkira Adina Equestrian's Insurance Waiver provided by their insurance agency. I understand working with horses comes with inherent risk.

Date*

Day

Month

Year

Signature (must be over the age of 18)*

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Name of person signing if under the age of 18.

Maths, Literacy and Communication Education with Horses

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Subscribe Form

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You will find us at

68 Easton Road

Chandlers Hill, South Australia. ABN: 89973109298

©2026 by Alkira Adina Equestrian

Photo credits:

Melissa Claire Photography

Tiffany Smith Photography

Two Tell a Tale

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