First name* Last name* Date of birth* Height* Weight* Address* Street Address Address Line 2 City County Post Code Phone number* Occupation* Email* Contact name / number in case of emergency*Medical conditions*Please details any disability or medical condition which may affect your ability to ride or which your instructor should be made aware of in the case of an emergency (e.g Back Problems, asthma, diabetes etcRiding Abilities - I would consider myself/my child to be a:*Lead Rein - unable to ride independently / Never RiddenBeginner - able to walk/trot independentlyNoviceIntermediateRiding Confidence Level - I would consider myself/my child to be:*Never Ridden - UnsureNervousUnder ConfidentConfidentHow many lessons have you/your child had in the last 12 months?*NoneLess than 55-1010+What do you believe your capabilities on an average horse to be?*Never ridden beforeRiding at walk (Off Lead Rein)TrottingCanteringGallopingRiding over 0.5m JumpsRiding over 0.75m JumpsWhat is your preferred day / time to attend lessons?* How did you hear about us?*FacebookInternetFriendsOtherIf other, please specify* Terms & Conditions* I have read and agree to terms & conditions.Riders under the age of 16 I accept full responsibility for my child and confirm that the pre-assessed abilities are correct. I ACCEPT MY CHILD RIDES AT HIS/HER OWN RISK Riders 16 years and over I acknowledge that riding is a risk sport and participation may hold potential danger, and that all horses may react unpredictably on occasions. I agree that I RIDE ENTIRELY AT MY OWN RISK. I understand that I must obey the instructions of the Instructor and comply with the health and safety requirements of this establishment. I confirm to the best of my knowledge that all the above details are correct, and I have read Parbold Equestrian Centre's Terms and Conditions (including the cancellation policy) and the Riders code of conduct and agree to abide by this. This form must be signed by a parent or guardian of riders under the age of 16. Riders Code of Conduct* I have read and agree to the Riders Code of Conduct.Date*
