Client Development Form

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First Name *

Surname *

Home address *

Postcode *

Mobile phone *

Emergency Contact Name and relationship *

Emergency contact number

Best Email *

Date of Birth (required for under 18)

YYYY

Riding Ability

Complete beginner

Beginner

Novice

Intermediate

Advanced

Please give details of any disability or medical conditions that might affect your ability to ride. This may include, but not be limited to, any back problems, conditions which can affect balance or blackouts/loss of consciousness/fitting. If you are unsure about any existing condition please consult your doctor.

Do you take any routine medication? *

Yes

If Yes, please give details

Have you ever suffered a serious injury? *

Yes

If yes, please give details.

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 and I understand that riding at any standard has inherent risk of injury. I accept that risk and agree that the Riding Instructor will not be liable for injury or damage to property unless it is caused by their negligence.

Data Protection Act 2018: I understand that the information I have given will be held in accordance with the Data Protection Act 2018 but may also be made available to insurers and other concerned parties in the event of an injury or accident. The lawful basis for this is legal obligation.

Required

Date *

YYYY

Name of person completing this form, and adult in case of an under 18 *

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