Rider Registration Form

Please complete before your first coaching session with Tom

Age
Have you ever suffered a serious injury?
Have you ever suffered discomfort while riding?
Have you ever been advised not to ride?

Please detail any disability or medical conditions that may affect your ability to ride. This may include, but not be limited to any back problems and any condition which can affect balance or cause blackouts/loss of consciousness/fitting for example. If you are unsure about any existing medical conditions please consult your doctor. Please give brief details of any medication or assistance we may need to know about that may affect your ability to ride safely.

Do you take any routine medication?

Emergency Contact Details

Please provide details of someone who can be contacted in case of emergency

Riding Ability Declaration

Please provide details of your riding experience

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Do you compete your horse?

Please use the space below to briefly outline your riding experience or add any further details about you and your horse.

General Declaration

I confirm that to the best of my knowledge all of the above details are correct. I have read the Horse Riders’ Code of Conduct below. I understand that riding at any standard has inherent risk that I may fall off and could be injured. I accept that risk and agree that the Riding coach will not be liable for injury or damage to property unless it is caused by their negligence. Where I am signing on behalf of a minor I have explained the Riders’ Code of Conduct to my child and we both accept the risk and agree that the Riding coach will not be liable for injury or damage to property unless it is caused by their negligence.

Data Protection Act 2018 (GDPR) Statement: I understand that the information I have given will be held in accordance with the Data Protection Act 2018 (the UK's implementation of the General Data Protection Regulation) but may also be made available to Insurers and other concerned parties in the event of any injury or accident.

The Horse Riders Code of Conduct

• I understand that riding at any standard has inherent risk and that all horses may react unpredictably on occasions.

• I may fall off and could be injured. I accept that risk.

• I understand that instructions are given for my safety and agree to follow instructions given to me.

• I understand that wearing an appropriate riding hat and body protector may reduce the severity of an injury should an accident happen and agree that I will always wear a riding hat while riding.

• I understand it is my choice whether or not I wear a body protector.

• I understand that my riding coach will make decisions based on information I give them and agree to always be honest and volunteer information about:

my abilities and riding experience

any previous riding accidents

any medical condition(s) which may affect my ability to ride

• I understand that competing carries enhanced risk over and above general riding and agree that if I chose to participate in any competition or event, it is up to me to ensure that I have the experience and ability to undertake the ridden tasks including any jumps which form part of it. If I am in any doubt, I will use my judgment and experience and not enter.

Signature (over 18s)

Guardian name and relationship to rider (for under 18s)

Guardian signature (for under 18s)

Address

2 Greenfield Avenue
Kettering
Northamptonshire
UK

Contact

07896937273

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