new Rider Details

Please Complete as much of this form as you are able. It is required for the Health and Safety assessment prior to riding.

Full Name *

Full address inc. Postcode *

Email *

Home Phone Number

Mobile Phone Number

Date of Birth *

Age *

Weight in Stones and Pounds *

Height in Feet and Inches *

Occupation

Have you ever suffered serious injury or discomfort whilst riding ? *

If YES please describe:

Please detail any disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency ( eg. back problems, diabetes, pregnancy): *

Name of Emergency Contact *

Emergency Contact Phone Number *

RIDING ABILITY: I consider myself to be a : *

RIDING ABILITY: How many times have you ridden in the last 12 months ? *

I acknowledge THAT RIDING IS A RISK SPORT AND HOLDS A POTENTIAL DANGER, and that all horses may react unpredictably on occasions. I understand that I must obey the instructions of the instructor and must comply with the health & safety requirements of the establishment. I reserve the right not to ride a horse allocated to me, and request a change of instructor. I confirm that to the best of my knowledge all the above details are correct. A parent / guardian of riders under the age of 16 must sign this form. I have read and understand the lesson booking and cancellation policy and agree to abide by it at all times. RIDERS AGED 16 YRS AND OVER: I confirm that the above pre-assessed abilities are correct and I agree that I ride entirely at my own risk. RIDERS UNDER 16 YRS OF AGE: I accept full responsibility for my child and confirm that the above pre-assess abilities are correct. DATA PROTECTION ACT 1998: Statement: I understand that the information I have given will be held in accordance with the Data ProtectionAct 1998 but may also be made available to insurers and other parties in the event of any injury or incident.

Name of Person signing this form *

Date *