0713807843
info@horse-sense.co.za

Application Riding

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An English Instructor and based on the Pony Club curriculum offers:

Riding lessons, therapeutic riding, assistance with your horses, fun events, specializing with beginner, novice or nervous riders.

Phone Debbie 071 323 5917

APPLICATION FOR RIDING INSTRUCTION

Surname / Family name:            …………………………………………………………………………..

First Name(s):                           (1)………………………………… (2) ………………………………..

What name do you prefer to be called by: (1) ………………………………(2)……….………………..

Your ID /Date of Birth:               (1)………………………………… (2) ………………………………..

Residential Address:                 …………………………………………………………………………..

(Please include Postal Code)         …………………………………………………………………………..

Postal Address:                        …………………………………………………………………………..

Telephone (Residence)              …………………………………Cellular:………………………………

Email Address:                         ………………………………… Fax No ………………………………

ANY MEDICAL CONDITION THAT SHOULD BE BROUGHT TO OUR ATTENTION?

(Allergies, Asthmatic, Epilepsy, etc) …………………………………………………………………………………….

Doctor Name & Contact No (for emergencies) ………………………………………………………………

Dentist Name & Contact No (for emergencies) ………………………………………………………………

Have you had riding instruction before? YES / NO. If YES – for how long & at what level are you?

…………………………………………………………………………………………………………………

 

If under18 years of age please complete the following. ADULTS i.e. over 18 years please let us know who to contact in the event of an emergency:

Contact Telephone Numbers:

 

GUARDIANS NAME:                 …………………………………………………………………………

Business: ………….……………   Cellular: ………………………     Home: ………………………

GUARDIANS NAME:                 …………………………………………………………………………

Business: ………….……………   Cellular: ………………………     Home: ………………………

ANOTHER CONTACT (relationship):       ………………………………………………………………

Business: ………….……………   Cellular: ………………………     Home: ………………………

 

I declare that the information provided herein is correct and true. I also declare that I have read, understand and accept the terms & conditions for participating in riding lessons with “Horse Sense”.       

 

APPLICANTS: SIGNATURE: …………………………………….. DATE: ………………………….

Signature of Parent / Legal Guardian if applicant is under 18 years of age acknowledging consent and acceptance on behalf of the minor child has been given

 

SIGNATURE: ……………………………………………………….. DATE: ………………………….