Riding Application form

Confidential Riding Application and Medical History Form
Riders name
Contact Number
Email
example@example.com
Age if under 18yo
Approximate weight of rider
Used only to ensure the correct horse is available. We currently have horses suitable to carry riders up to 100kg only.
Approximate height of Rider
How many times has the rider ridden in total?
The number of times the rider has ridden in the last 12 months
Lesson type wanted:
Frequency of lessons preferred:

Other
In the case of any emergency the following information is intended to assist:

Name and telephone numbers of contact people.** Legal gardian details must be provided if rider is under 18 years of age
Emergency contact name
Relationship with rider
Mobile
Format: (000) 000-0000.
Home
Emergency contact name
Relationship with rider
Mobile
Format: (000) 000-0000.
Home
Are there any learning difficulties that need to be discussed, so the Instructors/Guides are able to accommodate accordingly?
Please describe
Does the Rider have Ambulance Cover?
Do you (or your child) suffer from any of the following?
Please tick: Any pre-existing medical or other condition that may affect or risk other persons or myself.
Recent injury
Allergies
Please describe allergy
Tetanus Immunisation
It is particularly important that people dealing with horses are immunised against tetanus. Tetanus is normally given at five years of age as Triple antigen or CDT and at fifteen years of age as ADT.
Year of last tetanus immunisation
Medication
Is it necessary for you or your child to carry their own medication at all times?
Name of drug
Frequency
Dosage
Consent To Medical Attention
I authorise the instructor in charge to administer first aid and call an ambulance. I agree to bear any cost thereby incurred. Horse riding is a dangerous sport and Ambulance cover is recommended for any participant.

If under 18 this form must be signed by a parent or legal gaurdian
Signature
Date

MonthDayYear
Date
Payments and Cancellations Policy
Lesson must be paid for on the day via cash or card. Cancellation fees will be invoiced and must be paid prior to the next lesson. NDIS lessons will be invoiced and must be paid for within 7 days.

We understand that life happens and sometimes you cannot make your lesson. For any cancellations made with more than 24 hours notice you will be offered a make up lesson, you will not be charged a cancellation fee.

Cancellations within 24 hours will be charged 50% of the total lesson fee.

Cancellations within 2 hours will not be offered a make up lesson and will be charged full lesson fee

By signing below I agree to all of the above terms and conditions and conditions as well as the payment and cancellation policy.

Pants and enclosed toe boots with a smooth sole and small heel must be worn while riding and handling the horse, If you wear incorrect clothing and we do not have the correct size boots for you to borrow, you will forfeit you lesson. Helmets can be borrowed for your first 3 lessons, after that we ask that you purchase your own helmet.
I agree to the following: (all must be ticked to be accepted)
Privacy Statement – Privacy Act 1998
By completing this form you are supplying Ajay Equestrian with personal information about yourself. This information is needed to ensure your safety during your time with us. Ajay Equestrian is required to collect this information by our insurance company and by the department of Workplace Health and Safety. This information you provide will not be supplied to any other organisation or used for any other purpose than that which is stated above
Name

First NameLast Name
Please sign below to give Ajay Equestrian permission to charge your credit card for any outstanding lesson fees. We will contact you via phone for card details
Should be Empty:

Confidential Riding Application and Medical History Form

Allergies

Tetanus Immunisation

Medication

Consent To Medical Attention

Payments and Cancellations Policy

Privacy Statement – Privacy Act 1998