Participant Registration FormIf you are under 18 years, please ask your parent or guardian to complete this form on your behalf. Name * First Name Last Name Date of birth * MM DD YYYY Gender * Male Female Non-binary Prefer not to say Phone * If you are under 18 years, please ask your parent or guardian to supply their phone number. (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Weight * We currently only have horses that will carry up to max 13 stone (83kg). We are happy to advise you about alternative riding centres. Under 10 Stone or 63kg 10-11 Stone or 63-70kg 11-12 Stone or 70-76kg 12-13 Stone or 76-83kg Over 13 Stone or 83kg Height * Under 3' ft or 100cm Under 4' ft or 120cm 5' ft to 5'5" or under 165cm 5'6" to 6' ft or under 182cm Over 6' ft or over 182cm Ethnicity We are required to monitor this information so that we can apply for funding which supports under-represented groups. Asian Black UK/African/Caribbean White UK White Other Mixed Race Other Prefer not to say Emergency Contact Telephone First Name Last Name Doctor's Name and Surgery * Surgery Phone * (###) ### #### Ability What is your or the participant's riding ability? * Never ridden before Complete beginner - Walk on lead rein Beginner - Walk and trot independently Novice - Walk, trot and canter Intermediate - Ride confidently and independently Advanced - Highly experienced How often have you or the participant ridden in the last 12 months? * Never ridden before Returner - I haven't ridden in over a year Occasional - At least once a year Regular - At least once a month Frequent - Most weeks Daily - Every day Are you or the participant: * Please select all that apply Non-riding participant (stable yard activities) Rider - Under 18 Rider - Adult (over 18 years) RDA Participant (Riding for the Disabled Association) Pony Club Member Horse Loaner/Sharer Have you or the participant ever suffered a serious injury or discomfort while riding, or been advised not to ride? * Yes No Do you or the participant have ANY disability or medical condition? * This is including any learning, sensory or physical disability, ASD or mental health illness that we need to be aware of so that we can offer you the level of support that you need to take part in any activities and in case of emergency. Yes No Are you or the participant on any medication that may cause side-effects whilst riding or taking part in stable activities? * Yes No Do you have any conditions that may need attention during a session? * Yes No Other than your GP are you under the care of any other medical professionals? * Yes No Do any of the below apply to you or the participant? * Please select all that apply Problems with speech Problems with vision Problems with hearing Anxiety and mental health Difficulty understanding instructions Need help walking Use walking aids or appliances Use a wheelchair Other None Please give any additional information that may be useful Do you or the participant wish to become an RDA participant? * Yes No Declaration * To be completed by a parent or guardian if the participant is under 18. I declare that the information I have provided for myself (or my child if under 18) is correct to the best of my knowledge and agree that I/my child ride/s or participates entirely at my or their own risk. I understand that riding is a RISK sport and holds a potential danger and that horses may react unpredictably on occasions. I understand that I/my child may fall off and be injured - I accept that risk. I understand that wearing a riding hat, sturdy riding boots or wellies and body protector may reduce the severity of any injury should an accident happen and agree that I/my child will always wear a riding hat and strong, sturdy shoes/boots/wellies whilst riding, leading or grooming horses and I understand that I will not be able to ride without these. I understand it is my choice whether or not I/my child wear/s a body protector. I agree to providing additional information about any medical condition if requested by Park Lane Stables and am willing to get a report from a medical professional if necessary. I will inform the riding school if my/my child's condition changes in any way. 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 riding school. I understand that instructions are given for my own safety and I/my child must therefore obey the instructions of the instructor/riding centre staff and must comply with the Health & Safety requirements of Park Lane Stables. I understand that Park Lane Stables may refuse my request to ride or participate for safety or operational reasons. I understand that competing carries enhanced risk over and above general riding and agree that if I/my child choose/s to participate in any competition or event, it is up to me to ensure that I/my child has the experience and ability to ride the course, including any jumps which form part of it. If I am in any doubt, I will use my judgement and experience and not enter. I understand that the information I have provided will be processed and held securely in accordance with the General Data Protection Regulation (GDPR) 2018 and that the collection of data is a requirement necessary to enter into a contract with Park Lane Stables who will only use it for the purposes outlined on this form. [Park Lane Stables will not pass your data on to any third party without your consent, unless required by the law or, for example, for insurance purposes following an accident]. I understand that without my consent I/my child will not be eligible to ride at Park Lane Stables. I understand that my data will never be passed on to any third parties for marketing purposes. I understand and agree to the above declaration Photo and Video * From time to time, we may wish to take photographs to promote the stables e.g. for our website, newsletter or social media. I give my consent for Park Lane Stables to take photographs of me or my child for this purpose. Yes No Date MM DD YYYY Are you signing on behalf of a rider under the age of 18 or as a carer of a rider with disabilities? * Yes No Thank you!
