Charlie Hutton registration form - Charlie Hutton Equestrian

Charlie: +447836255730
www.charliehutton.net
E-Mail: hutton_charlie@hotmail.co.uk

Client Registration Form

Confidential – Please complete all sections below

Title

Full Name

Address

Postcode

Contact Number

Mobile Number

Date of Birth

Occupation

Have you, or the rider you are signing for, ever suffered a serious injury or discomfort while riding or been advised not to ride?

YES NO

If yes, please describe

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

Emergency contact

Name and Relationship

Contact Number

Riding ability/declaration – you MUST tick all boxes that apply

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be:

Riding my own horse – I accept full responsibility and the risks for myself and my horse whilst attending a lesson with Charlie Hutton Equestrian. Trying a horse for sale (if Yes please tick)

My ability dictates my competency whilst riding a new horse. I am a:

Beginner – I can walk/trot/canter (Prelim) Novice – I can ride through a Novice dressage test and or compete at grassroots level Intermediate – I can ride and compete at Novice affiliated Advanced – I can ride an Elementary test or above with affiliated scores above 65% Competition Rider – I am competing at Elementary and above with affiliated scores above 70%

I am confident jumping a course of fences over 50cm

YES NO

How many times have you/rider ridden in the past month?

NONE UNDER 12 12-30

I confirm in that to the best of my knowledge all of the above details are correct. (Please tick to accept)

I ACCEPT

I have read the Code of Conduct below. I understand that riding at any standard has inherent risk that I may fall off and could be injured. I accept that risk and agree that neither the venue nor coach will be liable for injury or damage to myself or property unless it is caused by their negligence. Where I am signing on behalf of a minor I have explained the Code of Conduct to my child and we both accept the risk and agree that the venue nor coach will not be liable for injury or damage to property unless it is caused by their negligence. I have read and understand the lesson booking and cancellation policy and agree to bide by it at all times. Data Protection Act 1998: Statement: I understand that the information I have given will be held in accordance with the Data Protection Act 1998 but may also be made available to insurers and other concerned parties in the event of any injury or accident.

Full Name

Date

I agree to all of the above

If signed on behalf of a minor

Full Name

Relationship to minor

Code of Conduct

•I understand that riding at any standard has inherent risk and that all horses may react unpredictably on occasions.

•I may fall off and could be injured. I accept that risk.

•I understand that instructions are given for my safety and agree to follow instructions given to me by team and coaches at the venue.

•I understand that wearing an appropriate riding hat and body protector may reduce the severity of an injury should an accident happen and agree that I will always wear a riding hat whist riding at the venue. I understand it is my choice whether or not I wear a body protector.

•I understand that the venue and coach will make decisions based on information I give them and agree to always be honest and volunteer information about:

•My abilities and riding experience.

•Any previous riding accidents.

•Any medical condition(s) which may affect my ability to ride.

•I understand that children are at particular risk around horses and agree that I will keep any children that I am responsible for, under close supervision when they are not being instructed by the venue.

•I understand that the venue or coach may refuse my request to ride for safety and operational reasons.

•I understand that riding horses for sale carries enhanced risk over and above general riding and agree that if I chose to participate, it is up to me to ensure that I have the experience and ability to ride the horse. If I am in any doubt, I will use my judgement and experience and ask not to continue.

Full Name

Date

Please tick box to full accept and sign agreement

I accept the above and have read through everything.