RIDER ASSESSMENT

Confidence Coaching –Rider assessment

Please take the time to complete this form so that we can better assist you in your confidence journey
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Do not enter area code.Format: (000) 000-0000.
EMERGENCY CONTACT NAME*

First NameLast Name
EMERGENCY CONTACT NUMBER*
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any medical conditions or injuries that may affect your ability to handle or ride horses? *
Please list any medical conditions or injuries you may have.
Please be aware that I am not a riding instructor, I am a confidence & groundwork coach.

These coaching sessions are designed to work with the human from a mindset angle to help give you tools to manage riding anxiety and worry.

The work that we do with the horses during our sessions will ALWAYS begin on the ground. This is where we are able to assess gaps in training, competency & confidence for both horse and handler.

We will then work at getting competent with timing and feel on the ground with your horse before we consider ridden sessions. This is to build both the handler AND the horses confidence.

I also encourage all horse owners to take out Recreational Insurance via Equestrian Australia. This is not compulsory, however, it certainly helps eliviate a lot of anxieties when we are interacting with our horses if we were to get injured in some way - we discuss this during our sessions as part of our "planning".

Please see the link below for more information. Most riders need only take out the RECREATIONAL RIDER policy.

https://www.wa.equestrian.org.au/get-involved/membership-categories
I have explored the EA Insurance information.
The following questions are judgement free - these are all just to give me an idea of where is best to begin your confidence journey.
less than 6 months6-12 months2-5 years10 years plus
rarely/returning after a breakmonthlyweekly2-3 times a weekHorse is not a ridden horse
NoYes - ongoingYes - occasionallyYes- mostly group clinics
Very confidentMostly confidentUp & downNervous but managingLacking confidence
Tell me a little about yourself & your horse, including what it is that are you hoping to achieve during your sessions?*
This information assists me to best tailor your session to what you need.
Is there anything else you would like me to know?
eg. how long you have had your current horse, any specific events that have led to a lack of confidence
Thank you so much for appyling for a confidence coaching session.

Spaces are limited and will be addressed as a first come first served basis.

Payment will be required once your application has been accepted and we agree on a session date.

Please take the time to complete the waiver as well which can be found via the link below.

https://form.jotform.com/251918957577073

Please choose a prefered date to begin your sessions below.
Please note your preferred day & time and I will confirm with you the availability *
I understand this questionnaire is used to help create a safe, supportive, and appropriate experience for both horse and rider. *
Please select the drop-down box to select YES.
Signature - I declare that the above information is true and correct.*

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Confidence Coaching –Rider assessment

The following questions are judgement free - these are all just to give me an idea of where is best to begin your confidence journey.