Rider registration form

Confidential: Please complete all sections below so we can provide the best possible cover in an emergency.

First name:

Surname:

Address:

Postcode:

Tel: (home)

Tel: (mobile)

Email:

Date of Birth:

Height:

Weight:

Please note that Buchan Community Farm's coach will discreetly use the applicant’s height and weight details to assess the suitability of available horses or ponies.

Have you ever suffered a serious injury?
YesNo

If Yes, please describe:

Have you ever suffered discomfort while riding?
YesNo

If Yes, please describe:

Have you ever been advised not to ride?
YesNo

If Yes, please describe:

Please provide details on any disability or medical conditions that may affect your ability to ride. This may include, but not be limited to
any back problems and conditions that can affect balance or cause blackouts/loss of consciousness/seizures, for example.

If you are unsure about any existing medical conditions, please consult your doctor.

Please provide details on any disability or medical conditions that may affect your ability to ride:

Do you take any other routine medication?
YesNo

If yes, please state:

Emergency Contact Name and Relationship:

Emergency Contact Tel:

Riding ability/Declaration. To be completed by the client:

Goals that you would like to reach within the next 12 months:

Date:

Print Name:

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 the inherent risk that I may fall off and I could be injured. I accept that risk and agree that the Riding Instructor will not be liable for injury or damage to property unless their negligence causes it.

Where I am signing on behalf of a minor or supported person, I have explained the Riders’ Code of Conduct to my child/supported person, and we both accept the risk and agree that the Riding Instructor will not be liable for injury or damage to property unless their negligence causes it.

Buchan Community Farm is committed to processing information in accordance with the General Data Protection Regulation (GDPR). The personal data collected on this form will be held securely and only used for administrative purposes.
But may also be made available to Insurers and other concerned parties in the event of any injury or accident.

Print Name:

Date:

If signed on behalf of a minor/supported person:

Relationship to minor:

The Horse Riders Code of Conduct

I understand that riding at any standard has inherent risk and that all horses may occasionally react unpredictably. As such, they may react to a situation or to the local environment so that the rider/ carriage driver may be unseated by accident. In the absence of any negligence on the part of Buchan Community Farm, I fully understand and accept that no liability will attach to either party.
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 I agree that I will always wear a riding hat while riding.
I understand it is my choice whether I wear a body protector.
I understand that my riding Instructor will make decisions based on information I give them and always agree to 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.

Dated:

Print Name: