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Trot Tots Registration Form
5th September - 24th October 2018 (8 sessions this term)
£64 (£8 per session)
Long Lane Equestrian, Long Lane, Kegworth, Derbyshire, DE74 2GA
www.longlaneequestrian.co.uk

Please fill in the details below to reserve your place for this block of sessions.
Payment details will be emailed to you once we have received your form.

Email address *
Child's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Preferred Session Time
Parent/Carer's Name *
Your answer
Address *
Your answer
Contact Number *
Your answer
Details of any disabilities, allergies or medical conditions *
Your answer
Emergency Contact (name & contact number) *
Your answer
I understand that equestrian activities have inherent risk and that participants could be injured. I accept that Long Lane Equestrian will not be liable for injury or damage to property unless it is caused by their negligence, and agree to follow the coach's instructions at all times. *
Required
I understand that my reservation will be confirmed only once payment for the full block of sessions has been received. *
Required
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