Full Name of Student *

Postal Address *

Age *

Contact Details: (Parent or Guardian / Bill Payer)

Parent or Guardian / Bill Payer - Name *

Parent or Guardian / Bill Payer - Email Address *

Parent or Guardian / Bill Payer - Best Contact Phone Number *

LEVEL OF EXPERIENCE (Please tick) *

No experience

Some experience (Have ridden for approx. 5 hours riding lessons)

Can ride independently (Walk, Trot)

Can ride independently Walk, trot, canter and jump

*

Students level of confidence: *

Low

Medium

High

Level of fitness: *

Unfit

Reasonably

Very Fit

Are you under 100kgs? *

Yes

No

To help you achieve your goals learning to ride. Please give us a brief outline on what you would like to achieve here at the Bartley Riding Academy *

Lesson Times (Please tick all options available as this increases your chances of fitting into our schedule.)

Note: Tick suitable times you can attend, even if the class type is not suitable as sometimes these levels change.

TUESDAY

3.45 Lead line 5+

4.00 - 4.55pm Beginners / Child

5.00 – 5.55pm Intermediate Teen / Adult

6.00 – 6.55pm Intermediate / Advanced Teen / Adult

WEDNESDAY

3.45 Lead line 5+

4.00 – 4.55pm Advanced Beginners

5.00 – 5.55pm Intermediate / Advanced Teens

6.00 – 6.55pm Advanced Beginner Adults / Teens

THURSDAY

3.45 Lead line 5+

4.00 – 4.55pm Beginners

5.00 – 5.55pm Intermediate

6.00 – 6.55pm Adult Private

Do you have any medical conditions or disabilities? (If so, please provide details) *

How did you hear about Bartley Academy Camps? *

Emergency Contact Details:

EMERGENCY - Name *

EMERGENCY - Best contact phone number *

*

I confirm that all details on this form are correct.

*

I have read and agree to Bartley Riding Academy's Terms & Conditions.

I am / am not the person responsible for payment. *

I am

I am not