Rider Full Name *

Your Email *

Your Phone Number *

Your Address *

Rider Date of Birth *

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

If yes, please describe

Doctors Surgery Name and Address *

Doctors Surgery Phone *

Emergency Contact Name and Relationship to Rider *

Emergency Contact Phone *

Alternative Emergency Contact Name and Relationship to Rider

Alternative Emergency Contact Phone

Horse and Rider Level of Training (flatwork, competing and comfortable height of jumping) If more than one horse please specify *

Disclaimer - I can confirm that the information I have provided is correct to the best of my knowledge
I understand that riding at any standard has inherent risk and agree that both the coaches and the venue will not be liable for injury or damage to property unless it is caused by their negligence
Where I am completing this form on behalf of a minor (under the age of 18 years old) we both accept the risk and agree that both the coaches and the venue will not be liable for injury or damage to property unless it is caused by their negligence
Data Protection Act 1998 - Statement - I understand that the information that I have given will be held in accordance with the Data Protection Act 1998, and in accordance with GDPR, but may also be made available to insurers and other concerned parties in the event of an injury or accident *
I have read and agree to the disclaimer