Riders registration form for any sessions with Samantha Jarvis Equine Coaching
Please fill out the following form with correct upto date information.
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Name *
Email *
Address *
Phone number *
Date of birth *
Preferred pronouns *
Emergency contact name and relationship *
Emergency contact telephone number *
Level of riding experience *
Short term goal *
Medium term goal *
Long term goal *
Please detail any disability, injuries or medical issues which may affect your ability to ride. *
Do you take any routine medication please detail if answer is yes. *
Required
Have you ever suffered from a serious injury, if yes please detail *
Required
I confirm to the best of my knowledge that the above information is filled in correctly *
Required
I have read the horse riders code of conduct below and accept that riding at any level is a risk sport and comes with a risk of injury. I accept the risk and agree the accredited professional will not be liable for injury or damage to property unless it is caused by there negligence. *
Required
Data protection act 2018, I understand that the information I give will be stored in accordance with the data protection act 2018, but may be shared with insurers and other necessary parties in the case of a accident or a injury. *
Horse riders code of conduct
● I understand that riding of any standard has inherent risk and I accept horses at times are unpredictable
● I may fall off and could lead to injury, i accept that risk
● I understand instructions are given for my safety and agree to follow the instructions given
● I understand that wearing appropriate riding safety equipment will reduce my risk of injury incase of a fall. I agree to always where a riding hat when mounted. Body protectors are strongly advised, and must always be worn for xc sessions
● I understand it is my choice to wear or not wear a body protector in sessions other than xc sessions
● I understand my accredited professional with make decisions based on the information I have given, on the horse, my ability, experience and previous injuries. It is my responsibility to ensure the accredited professional has the correct upto date information *
I have read all the above and consent and all the information I have given is correct and upto date. In case of signing for a minor I have explained the horse riders code of conduct *
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