Rider Registration Form

Name *

First

Last

Nickname

Address *

Mobile number *

Home telephone number

Work number

Email *

Date of Birth *

Age *

Height *

Weight *

Occupation

Banking name *

This is the name that will appear with any BACS payments you may make to us in the future and helps us to reconcile our bank statement i.e. we may know you as Joe Bloggs but payments may show in the name of another person or joint account and we struggle to match the two!

Have you (or the person you are completing this form for) ever suffered a serious injury or discomfort while riding or been advised not to ride? *

Yes
No

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. *

Emergency Contact Name & Number: *

Second Emergency Contact Name & Number:

Doctors Name & Number: *

I consider myself (or the minor for whom I am completing this form on behalf) to be a: *

How many times have you/rider ridden in the last 12 months: *

None
Under 12
12-40
40+

What do you believe yours or the person riding' capabilities to be? *

RIDERS UNDER 16 YRS OF AGE : I accept full responsibility for my child and confirm that the above pre-assessed abilities are correct. I accept my child rides at his/her own risk.

Yes

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.

Yes

DATA PROTECTION ACT 1998: I understand that the information I have given will be held in accordance with the Data Protection Act 1998 but may also be made available to Insurers and other concerned parties in the event of any injury or accident. *

Yes

I understand that I must obey the instructions of the instructor and must comply with the Health & Safety requirements of the establishments. I reserve the right not to ride a horse allocated to me or my child and or request a change of instructor. *

Yes

I agree that Glapthorn Manor Stables may photograph myself/my child for promotional use on the business website or social media. *

Yes
No

I acknowledge THAT RIDING IS A RISK SPORT AND HOLDS A POTENTIAL DANGER, and that all horses may react unpredictably on occasions. *

Yes

I confirm that to the best of my knowledge all the above details are correct by completing and submitting this form *

Please insert your name and today's date.

Finding Us

Address:

Contact Details

License Number