Nine Acres

Excellence in Equitation

Registration Form for Freelance Clients

Please note this form must be accurately completed and signed before any lesson is undertaken.

Name
Address
Tel (Home) / Tel (Mobile)
E-mail
Preferred method of contact

Emergency Contact Details

Contact Name / Relationship / Tel number(s)
Doctors Name / Surgery / Tel

Details on you and your horse

Your reason for booking your lesson: (Please tick all that apply) / Please use this space to tell us a little about your horse.
I am not having any specific problems, but enjoy learning and improving both my horse and myself. / Name……………………… Height………… Age………
Length of time owned by you………………………….
Any additional information / areas you want to work on:
I feel my riding is not at the level I would like it to be, and am keen to improve.
I feel my horse is not at the level I would like him / her to be, and would like guidance on further training.
I find I am lacking confidence and would like help in achieving my goals.
My horse is displaying “problem” behaviour, and I would like advice on what to do.
I would describe myself as: / Please give brief details of your experience handling and riding horses.
Having not ridden before
A beginner rider
A novice rider
An intermediate rider
An experienced rider

With the horse you are booking your lesson on, what do you believe are your capabilities ? **Please indicate all that apply**

Riding at walk / Sitting trot with stirrups / Rising trot with stirrups / Trot work without stirrups / Cantering / Hacking
Riding over jumps upto 0.50cms (18”) / Riding over jumps upto 0.75cms (2’6”) / Riding over jumps upto 0.90cm (3’) / Riding over XC fences

Medical Information

Have you or the person you are completing this form for ever suffered a serious injury or discomfort while riding, or been advised not to ride? Yes / No
If Yes, please give details:
Do you have any disability, injury or medical condition that may affect your ability to ride, or that your instructor should be aware of in case of emergency? Yes / No
If yes, please give details:
How did you hear about Nine Acres Equestrian?
Personal recommendation.
Attended a training / demo event
Internet search engine
Social media site
Other (please state)

Page 3 of 3

Riders under 16years of age: I accept full responsibility for my child and confirm the above pre-assessed abilities are correct. I accept my child rides at his / her own risk.

Riders aged 16 or over. I confirm that the above pre-assessed abilities are correct and I agree that I ride entirely at my own risk.

I understand that the information I have given on pages 1 and 2 will be held in accordance with the Data Protection Act 1998 but may also be made available to Insurers or other concerned parties in the event of any injury or accident.

I understand that I must obey the instructions of the instructor, and must comply with health and safety requirements of the establishments. I understand I must inform Nine Acres Equestrian of any alterations to this information, especially Contact details, next of kin of medical information.

I confirm that to the best of my knowledge all the above details are correct. A parent or guardian of riders aged under 16 years must sign this form.

I acknowledge that riding is a risk sport and holds a potential danger and that all horses / ponies may react unpredictably on occasions. If signing on behalf of rider named on page 1, please state relationship to rider.

Signature
Print name
Date