Rider Registration Form 
Health and safety legislation requires me to be aware of the issues my clients may be facing so please fill in this form for me, and update it if necessary. I will remind you at the beginning of each year to check that your information is still current.
Sign in to Google to save your progress. Learn more
First Name *
Surname *
Date of Birth *
MM
/
DD
/
YYYY
Address
Post code
Email *
Phone number - best for contacting  you on. *
What level are you riding at? *
Required
What are your short term goals (next 3 months) for working with me?
What are your medium term (next 6 months) goals.
What do you hope to achieve in the next 12 months?
Please detail any disability, injury or medical conditions that may affect your ability to ride.  This may include, but not be limited to; any back problems, conditions which can affect your balance or blackouts/loss of consciousness/fitting. If you are unsure about any existing medical condition please consult your doctor.
Do you take any routine medication? *
If yes please give details.
Have you ever suffered a serious injury? *
If yes please give details.
Emergency contact name and relationship to you. *
Best emergency contact number *
Agreement *
Required
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ros D Equine.

Does this form look suspicious? Report

Google Forms