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R S VETERINARY & RIDER PHYSIOTHERAPY RIDER BIOMECHANICS CLINIC BOOKING FORM
RIDER BIOMECHANICS CLINIC 27 JULY
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PAYMENT SECURES PLACE & TO BE MADE AT TIME OF BOOKING QUOTING SURNAME & RIDER CLINIC AS REF
AMOUNT £70 (includes school hire)
BACS DETAILS
R S PHYSIOTHERAPY
S/C 23-69-72
A/C 29578659
ANY TIME PREFERENCE
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11.30am
12.30
NAME
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AGE IF UNDER 18
(Parental/ Guardian consent will be required)
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ADDRESS
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PHONE NUMBER
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EMAL
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DO OU HVE ANY PRE-EXSTING MEDICAL CONDITIONS OR INJURIES WHICH MAY AFFECT YOUR ASSESSMENT OR ANY SPECIAL REQUIREMENTS?
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EMERGENCY CONTACT
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Although every attempt will be made to minimise risk, riding is a risk sport and the Mounted part of the assessment will be at your own discretion.
This booking acts as your consent to Physiotherapy assessment. Video recording may form part of your assessment. Please advise prior to your assessment if you would prefer not to be videoed
SIGNED/ DATE
(Parent/ Guardian if under 18)
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