Registration and Risk Advisory From 2024

Registration and Risk Advisory Form

2024
Section A - Terms, Conditions and Risk
The sections below are for an Adult Rider or
a Parent or Guardian of Child rider (under-18 at the time of completing the form)

I hereby apply for myself and/or on behalf of my child to participate in equestrian programmes or activities organised or operated by Hitchmoughs Riding School LTD.

By completing this form I understand it will form the basis of an agreement between me and Hitchmoughs Riding School LTD.

By signing this document, I do hereby acknowledge and accept the following:

1. That all sporting activities have an element of danger and riding is no exception.
2. That I or my child may suffer serious personal injury or worse, as well as loss of property as a result of exposure to risks and hazards associated with riding as a sport and/or interacting with horses.
3. I hereby agree to abide by all rules and regulations laid down by the Riding Establishment, I hereby agree that:
a. I and/or my child will wear approved head gear and suitable clothing and footwear when riding.
b. I and/or my child will follow all instructions meticulously.

4. I clearly understand that by accepting the Riding Establishment’s terms and signing this agreement, I am accepting the risks. I will exercise due care and attention. It is my decision whether or not to carry insurance against loss.
Do agree with the above statements?

I agree
I and/or my child acknowledge and accept that riding is a risk sport.*

I agree
I acknowledge that this Establishment may use my address and telephone number to contact me in the future. The information will not be shared to any other thirds parties*

I agree
I agree that photographs or recorded images may be taken during or at AIRE related activities, which may include myself or my child, may be used in the promotion of this centre.*

I agree
I have read, understood and agree to adhere to the Horse Riders' Code of Conduct which is found on our website here: https://www.hitchmoughs.ie/rcoc.*

I agree
Section B - Contact Details
Rider's Name*
Rider's Date of Birth*

DayMonthYear
Date
Parents Name (if Rider is a minor)

First NameLast Name
Relationship to Minor
Address*

Street Address

Street Address Line 2

CityState / Province

Eircode
E-mail*
example@example.com
Primary Contact Number*
Alternative/Emergency Contact Number, name and relationship to Rider*
In case we cannot reach the primary contact person and number

Section C - Personal and Medical Details

Details required for us to assess your ability and suitability for horse and activities
Weight*
Please record in KG
Height*
Please record in CM
Occupation
Have you, or the rider you are signing for, ever suffered an injury or discomfort while riding or been advised not to ride?*

YesNo
If Yes to the above question, please detail it below
Please detail any disability or medical conditions that may affect your ability to ride. This may include but not be limited to any back problems and any conditions, which can affect balance or cause blackouts/loss of consciousness/fitting and so on.*
It is vital you tell us about any conditions so we can act appropriately to try ensure your safety
Do you or your Rider have now, or have you ever had any of the following: ASTHMA, AUTISM, DYSPRAXIA, DIABETES, DYSLEXIA, EPILEPSY, HEART, HEARING, BACK or SIGHT PROBLEMS or NERVOUS DISORDERS*

YesNo
If yes to any of these, please state the condition concerned and, in your own interest, state whether or not your doctor is in agreement with you riding:
Is there any further information that the Coach should be aware of to make the lesson more beneficial and safe for the Rider?
Women only: Are you pregnant?

YesNo
If you become pregnant after filling in this form you should inform a member of staff immediately

Confirmation and Signature
I confirm by signing below that to the best of my knowledge all of the details in this entire form are correct.

By signing below, I understand that riding at any standard has inherent risks, that I may fall off, or be injured due to particiation in a lesson, including the preparation and finalisation of the lesson. By signing below, I accept that risk and agree that the Hitchmough Riding School LTD will not be liable for injury or damage to property. Where I am signing on behalf of a minor I have explained the Riders’ Code of Conduct to my child and we both accept the risk and agree that the Hitchmough Riding School LTD will not be liable for injury or damage to property unless it is caused by their negligence.

By signing below I confirm I have read and understand the lesson booking and cancellation policy which is available on our website in the 'About' section and agree to bide by it at all times.

Data Protection Statement: By signing below, I understand that the information I have given will be held in accordance with current Data Protection standards and laws but may also be made available to insurers and other concerned parties in the event of any injury or accident.
Signature as Rider or Responsible person for a minor

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Full name of Signing Person*
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Registration and Risk Advisory Form

Section A - Terms, Conditions and Risk

Section B - Contact Details

Section C - Personal and Medical Details

Section D: Riding Ability

Confirmation and Signature