Confidential Riding Application and Medical History Form

Riding experience


In the case of any emergency the following information is intended to assist:

Name and telephone numbers of contact people. ** Legal gardian details must be provided if rider is under 18 years of age



Allergies

Tetanus Immunisation

Medication

Consent To Medical Attention

I authorise the instructor in charge to administer first aid and call an ambulance. I agree to bear any cost thereby incurred.

I agree to the terms and conditions
Click here to read Terms and Conditions.

Privacy Statement – Privacy Act 1998

By completing this form you are supplying the Provider with personal information about yourself. This information is needed to ensure your safety during
your time with us. The Provider is required to collect this information by our insurance company and by the department of Workplace Health and Safety. This information you provide will not be supplied to any other organisation or used for any other purpose than that which is stated above