[{"type":"header","label":"Rider Registration Form Balcultry EC","className":"waiver-header-element"},{"type":"paragraph","label":"

Registration and Risk Advisory

By completing this form you are confirming and agreeing to the following statement. I accept there is a inherent risk of injury as riding is a high risk sport. I am also aware of the risks, danger and hazards through out the grounds of Balcultry Stables, although every effort is made by Balcultry EC, to ensure my safety, accidents do happen. In the event of an accident or injury to horse, rider or supporter, or damage to property when at Balcultry Stables EC I understand that liability will not be accepted.

SECTION D: 1The Proprietors and Management reserve the right to refuse an applicant permission to ride at this Establishment.

2. Accurate information on previous riding experience must be supplied before acceptance.

3. Regulation headwear, footwear and clothing must be worn. Headwear and footwear brought by clients may be examined by management for suitability. All instructions from management and staff must be meticulously followed in the interest of safety.

4. Horses will be matched to riders in accordance with rider’s statement of experience.

5. Riders are recommended to have Personal Accident Insurance Cover.

This Establishment is approved and makes every reasonable effort to ensure the safety of the rider. Horses are unpredictable and there is always a risk that a rider and/or horse may fall or a horse go out of control. These risks can never be eliminated. In the interests of providing a good and reasonable service without fear of unreasonable claims for injuries, we do require the following disclaimer to be accepted as part of the conditions of riding at this Establishment: “The proprietor(s), management and employees of this Establishment shall not be liable for, nor do they accept responsibility for, any personal injury, loss or damage sustained by any person or persons (including customer/rider) whether arising under the express or implied terms of this contract, whether direct or indirect and including consequential losses arising out of any of the activities of this Establishment or in any other way whatsoever which does not arise from a negligent act or omission of the proprietor(s)/management/employees.” I understand and agree that by accepting the Riding Establishment’s terms and signing this agreement, I am accepting that there are risks of injury and I must exercise due care and attention.

","className":"waiver-legal-element"},{"type":"text","required":true,"label":"Name of Rider","className":"form-control","name":"text-1701006142175"},{"type":"text","required":true,"label":"Post address","className":"form-control","name":"text-1701006160125"},{"type":"text","required":true,"label":"Email Address","className":"form-control","name":"text-1701006178204"},{"type":"text","required":true,"label":"Mobile Contact","className":"form-control","name":"text-1701006194372"},{"type":"text","required":true,"label":"Emergency Contact Name","className":"form-control","name":"text-1701007484052"},{"type":"text","required":true,"label":"Relationship with Contact","className":"form-control","name":"text-1701007988260"},{"type":"text","required":true,"label":"Age of Rider","className":"form-control","name":"text-1701006213135"},{"type":"text","required":true,"label":"N.B. Riders Details; Height (limit Ponies 157cm/ 5'2\" Horses 1.73cm/ 5'7\")","className":"form-control","name":"text-1701007360866"},{"type":"text","required":true,"label":"N.B. Riders Details; Weight (limit; Ponies 8 stone /50kg; Horses 12 stone /75kg)","className":"form-control","name":"text-1701007381793"},{"type":"paragraph","label":"Please be aware that all riders must be assessed before joining our Group Lessons. Our lessons schedule is on our booking app Hopoti.com. "},{"type":"radio-group","required":true,"label":"How Long are you/ they Riding ?","name":"radio-group-1701008964209","other":false,"values":[{"label":"0 ","value":"option-1"},{"label":"6 months","value":"option-2"},{"label":"1 year +","value":"option-3"},{"label":"5 years +","value":"option-4"},{"label":"","value":"option-5"}]},{"type":"checkbox-group","required":false,"label":"Riders Level / Experience","toggle":false,"name":"checkbox-group-1701009545031","other":false,"values":[{"label":"Beginner - Only ridden a few times. ","value":"option-1","selected":true},{"label":"Novice - I can walk and trot, unaided.","value":"option-2"},{"label":"Intermediate - I can canter and jump a small course of fences. ","value":"option-3"},{"label":"Advanced - I am riding jumping a course of fences of 90cm. I can ride without of stirrups.","value":"option-4"},{"label":"Other","value":"option-5"}]},{"type":"radio-group","required":false,"label":"What fence height are you comfortable jumping?","name":"radio-group-1701010098559","other":false,"values":[{"label":"None - I prefer flatwork / dressage","value":"option-1"},{"label":"Jumps X Poles","value":"option-2"},{"label":"Jumps 50 cm - 60cm","value":"option-3"},{"label":"Jumps 70 cm - 80 cm","value":"option-4"},{"label":"Jumps 90cm - 1m","value":"option-5"},{"label":"1.10 cm +","value":"option-6"}]},{"type":"checkbox-group","required":true,"label":"Additional Information ","description":"This information will help us with matching our riders with our horses. This information will help us with matching our riders with our horses","toggle":false,"name":"checkbox-group-1701010528462","other":false,"values":[{"label":"Do you have your own horse?","value":"option-1","selected":true},{"label":"Have you ever owned or shared a horse?","value":"option-2"},{"label":"Do you have any equine qualifications? ","value":"option-3"}]},{"type":"checkbox-group","required":true,"label":"Have you ever suffered a serious injury whilst riding, or been advised not to ride? Yes/No? If yes please give details:","toggle":false,"name":"checkbox-group-1701009136951","other":false,"values":[{"label":"No","value":"option-1"},{"label":"Yes - please give more details below","value":"option-2"}]},{"type":"textarea","required":false,"label":"If you have been injured, please give more details here","className":"form-control","name":"textarea-1701009209487"},{"type":"textarea","required":false,"label":"Please detail any disability of 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/fitness.","className":"form-control","name":"textarea-1701009515175"},{"type":"checkbox-group","required":false,"label":"Health & Communications","description":"Please tick yes when appropriate","toggle":false,"name":"checkbox-group-1701012022887","other":false,"values":[{"label":"Understands all communication","value":"option-1"},{"label":"Good speech","value":"option-2"},{"label":"Good hearing","value":"option-3"},{"label":"Prone to having seizures","value":"option-4"},{"label":"Good mobility","value":"option-5"},{"label":"Other please give more details below","value":"option-6"}]},{"type":"textarea","required":false,"label":"Health and Coms ","description":"Please give more details if needed","className":"form-control","name":"textarea-1701012661506"},{"type":"checkbox-group","required":false,"label":"Please say yes if we can take your photo and use it on our social media !","description":"On occasion your session maybe videoed or photographed, do you consent to these (flattering ones) being used for promotional purposes?","toggle":false,"name":"checkbox-group-1701011010133","other":false,"values":[{"label":"Yes","value":"option-1","selected":true},{"label":"No","value":"option-2"}]},{"type":"checkbox-group","required":true,"label":"Electronic signature consent","className":"waiver-accept-element","name":"checkbox-group-1701006032732","values":[{"label":"Insert accept text here","value":"option-1"}]},{"type":"signature","required":true,"label":"Signature","className":"waiver-signature-element","name":"signature-1701006032736"}]