Participant Application Form

  • Scropton Horse Centre

    Home of Scropton Riding for the Disabled

    Registered Charity No 1170646

  • Participant Application Form

  • If you are under 18 or someone else normally completes your paperwork for you, this form should be completed and signed on your behalf by your parent or legal guardian.

    All information will remain confidential for use by centre personnel only.

    This application form needs to be completed in one sitting so please make sure you have the following information to hand so that you can complete it in full:

    • Personal and contact details
    • Details of any previous relevant experience
    • If joining as part of a school or training centre, or through a referral from a Council Social Care, Education or Health Department, a contact name/ contact details are needed
    • Health Information including details about medical practitioners and medications
    • Two emergency contact names & phone numbers
    • For anyone signing on behalf of a participant other than a parent, you will need to upload documentation to show that you have the authority to sign on the participants behalf
       

  • YOUR DETAILS

  • Date of Birth*
     - -

  • Address

  • Format: 00000 000000.
  • Format: 00000 000000.
  • Which activities are you interested in taking part in?

  • RIDING

  • If you are applying to ride, please tell us about any previous riding experience:

  • What level have you ridden at?
  • How many times have you ridden in the last 12 months
  • What do you believe your capabilities on a horse are?

  • If you are applying to ride, we need to know your height and weight (in your riding gear) so that we can provide an appropriate horse. The maximum weight of rider we can accommodate is 13 stone/82kg.

    To convert your height from feet & inches to metres click here

    To convert your weight from stones & pounds to kg click here

    If you are applying for non-ridden activities then you can reply to these questions with a 0

  • APPLYING THROUGH ANOTHER ORGANISATION

  • If you are joining as part of a school or training centre, or through a referral from a Council Social Care, Education or Health Department, please fill in the details below.

    You do not need to provide this information if you are joining as an independent participant.

  • Format: 00000 000000.

  • INFORMATION ABOUT YOU

  • Speech

  • Do you have any problems with speech?*

  • Eyesight

  • Do you have any problems with eyesight?*
  • Do you wear glasses / contact lenses?*

  • Hearing

  • Do you have any problems with hearing?*
  • Do you wear a hearing aid or cochlear implant?*

  • Mental Health

  • Do you experience anxiety, depression or low mood?*
  • Do you experience phobias, OCD or panic attacks?*
  • Do you experience eating disorders?*
  • Do you experience any other mental health difficulties?*

  • Learning Disability

  • Do you live with a learning difficulty or learning disability?*

  • Behaviour

  • Has your behaviour caused you to be at risk of being excluded from any club or organisation?*

  • Instructions

  • Do you have difficulty understanding simple instructions?*

  • Walking

  • Do you need help with walking?*
  • Do you use any walking aids?*
  • Do you wear orthopaedic appliances?*
  • Do you use a wheelchair?*
  • Would weight bearing be a problem?*

  • EMERGENCY CONTACTS

  • Please provide details of 2 people who can be contacted in the case of an emergency

  • Emergency Contact 1

  • Format: 00000 000000.

  • Emergency contact 2

  • Format: 00000 000000.

  • CONSENT

  • Photographs

  • Do you consent to photographs being taken by a camera or phone, during activities for publicity and training purposes?*

  • First Aid

  • Do you consent that, if an emergency medical situation arises, we may act in loco parentis for administration of first aid and/or other medical treatment deemed necessary by qualified first-aider or medical practitioner?*

  • Behaviour Code

  • Do you understand and consent to our Behaviour Code for participants and parents/carers ?*

  • You can read our Behaviour Code for Participants here

    You can read our behaviour Code for Parents/Carers here

  • Data protection

  • Do you consent to us maintaining your personal data in line with the charity’s privacy notice and data protection policy ?*

  • You can read our Privacy Notice here

    You can read our Data Protection Policy here

  • Communication

  • Do you consent to receiving centre news via the email address you have provided?*
  • Do you consent to contact via text on the mobile number you have provided for important information only?*

  • Membership Association

  • Would you like to be sent more information about becoming a voting member of our charity?*

  • DECLARATION AND SIGNATURE OF ACCEPTANCE

  • Please ensure that you read and sign to accept all of the following:

    1.   I wish to apply as a participant in the centre's activities and confirm that all details given are accurate to the best of my knowledge.  I agree that should a centre coach require additional information about me at any time, I will provide what is required. If required, I am willing to obtain reports from a specialist practitioner who is familiar with my condition and understand that I may be required to pay a fee for such a report.

    2.   I recognise that activities with horses are a risk sport and I voluntarily accept the risks involved.  I further understand the need for the participant or carer to take all reasonable precautions.  In the absence of any negligence on the part of the centre, I accept that no liability will attach to them.

    3.   I will immediately inform the centre of any change in my:
            - address, email or contact numbers
            - medication or in my mental or physical health condition
            - changes to my emergency contact details

    4.   For the welfare of the centre's horses and ponies, all riders will be weighed on  the centre's scales at least once per term in their complete riding clothes. This information will be kept confidential on their rider files and only the centre's staff will have access to this information. This information will only be used for the purpose of allocating a suitable horse or pony.  

    5.   Participants need to provide their own riding hat that conforms to valid safety standards (Standards currently include PAS015:1994 or PAS015:1998, ASTM F1163 (2004a), SNELL E2001 or VG1). We have a small number of hats that may be borrowed for initial sessions, but regular participants will need their own hat.

    6.   If I engage in any behaviour that falls outside the Scropton Behaviour Agreement, this may result in immediate termination of my sessions without notice.

  • I have read and agree to these terms and conditions*
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