Name of rider

Names of parent/guardian

Level of riding experience
Beginner - has ridden 1-20 timesIntermediate - has completed between 2-6 terms of lessonsAdvanced - more than 2 years of lessons

As the authorised parent/guardian, I assume full responsibility for injury, death or property damage that I or those in my care may suffer as a result of partaking in horse riding and related activities with Hills and Hollows Ponies.

I permit the First Aid Responder to issue first aid as required.

I acknowledge that the risks of horse riding and related activities have been explained to and accepted by the participant and the participant has agreed to obey instruction and safety procedures.

I accept a payment contract with Hills and Hollows for the service of:
Weekly lessonsHalf day campA single lessonAttendance

Any medical information

Emergency contact name

Emergency contact number