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 have read, in full, the Disclaimer/Waiver Form on the Forms tab of the Hills and Hollows website and I agree with all aspects including an understanding of the dangers and nature of the activity, the complete exclusion of liability and the waiver from injury or death as outlined in the Waiver Section.

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

Contact Email