07889 721 471

info@ballylagantrailrides.com

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Gallery
Contact

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Address

12 Ballylagan Road,
Straid, Ballyclare,
Co. Antrim, BT39 9NF

Contact Us

Phone 07889 721 471

Contact Us

Email info@ballylagantrailrides.com

RIDER REGISTRATION FORM

STRICTLY CONFIDENTIAL

PLEASE COMPLETE ALL SECTIONS & BOXES

"*" indicates required fields

Step 1 of 3

33%

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Date of Birth*

DD slash MM slash YYYY

Age*

Weight*

Height*

Occupation*

Have you (or the person you are signing for) ever suffered a serious injury or discomfort while riding or been advised not to ride?*

Yes

PLEASE DETAIL ANY DISABILITY OR MEDICAL CONDITIONS THAT MAY AFFECT YOUR ABILITY TO RIDE OR WHICH YOUR INSTRUCTOR SHOULD BE AWARE OF IN CASE OF AN EMERGENCY. OR TYPE NONE.*

EMERGENCY CONTACT & DOCTOR’S DETAILS

Contact Name*

Doctor*

Relationship*

Surgery / Town*

Telephone*

Mobile*

RIDING ABILITY - YOU MUST TICK ALL BOXES THAT APPLY

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

Never Ridden Before

Beginner

Novice

Intermediate

Advanced

How many times have you/rider ridden in the last 12 months*

None

Under 12

12-40

40+

What do you believe your or the person riding’s capabilities on a horse or pony to be:*

Riding at a walk

Trotting with Stirrups

Trotting without Stirrups

Cantering

Hacking

Riding over jumps up to 0.5m (I8”)

Riding over jumps up to 0.75m (30”)

Riding over cross country jumps (30”+)

RIDERS UNDER 16 YRS OF AGE: I accept full responsibility for my child and confirm that the above pre-assessed abilities are correct. I accept my child rides at his/her own risk

RIDERS AGED 16 YRS & OVER: I confirm that the above pre-assessed abilities are correct and I agree that I RIDE ENTIRELY AT MY OWN RISK. DATA PROTECTION ACT 1998: 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. I understand that I must obey the instructions of the instructor and must comply with the Health & Safety requirements of the establishments. I confirm that to the best of my knowledge all the above details are correct. A parent or guardian of riders under the age of I6 must sign this form. I acknowledge that RIDING IS A RISK SPORT AND HOLDS A POTENTIAL DANGER, and that all horses may react unpredictably on occasions.

Tick this box to give permission to be photographed for advertising and social media purposes*

Yes

Print Name*

Date*

DD slash MM slash YYYY

Signature*

RELATIONSHIP (IF SIGNING ON BEHALF OF RIDER): OR TYPE NONE.*

Address

12 Ballylagan Road,
Straid, Ballyclare,
Co. Antrim, BT39 9NF

Contact Us

Phone 07889 721 471
Email info@ballylagantrailrides.com

Bookings

To secure a booking fill in a
Rider Registration Form
along with your full payment

Payments

Send a secured payment with PayPal

07889 721 471

info@ballylagantrailrides.com

Contact Us

Send A Message

Address

Contact Us

Contact Us

RIDER REGISTRATION FORM

STRICTLY CONFIDENTIAL

EMERGENCY CONTACT & DOCTOR’S DETAILS

RIDING ABILITY - YOU MUST TICK ALL BOXES THAT APPLY

RIDERS UNDER 16 YRS OF AGE: I accept full responsibility for my child and confirm that the above pre-assessed abilities are correct. I accept my child rides at his/her own risk

Address

Contact Us

Bookings

Payments

Ballylagan Trail Rides Safeguarding Children & Young People Policy Statement