Belvoir Vale Horse Centre

Home of Belvoir Vale Riding for the Disabled

Registered Charity No 1162970

If you are under 18 or someone else normally completes your paperwork for you, this form should be completed and signed on your behalf by your parent or legal guardian.

All information will remain confidential for use by centre personnel only.

This application form needs to be completed in one sitting so please make sure you have the following information to hand so that you can complete it in full:

• Personal and contact details
• Details of any previous relevant experience
• If joining as part of a school or training centre, or through a referral from a Council Social Care, Education or Health Department, a contact name/ contact details are needed
• Health Information including details about medical practitioners and medications
• Two emergency contact names & phone numbers
• For anyone signing on behalf of a participant other than a parent, you will need to upload documentation to show that you have the authority to sign on the participants behalf
  

YOUR DETAILS

Address

RIDING

If you are applying to ride, we need to know your height and weight (in your riding gear) so that we can provide an appropriate horse. The maximum weight of rider we can accommodate is 13 stone/82kg.

To convert your height from feet & inches to metres click here

To convert your weight from stones & pounds to kg click here

If you are applying for non-ridden activities then you can reply to these questions with a 0

APPLYING THROUGH ANOTHER ORGANISATION

If you are joining as part of a school or training centre, or through a referral from a Council Social Care, Education or Health Department, please fill in the details below.

You do not need to provide this information if you are joining as an independent participant.

INFORMATION ABOUT YOU

Speech

Eyesight

Hearing

Mental Health

Learning Disability

Behaviour

Instructions

Walking

EMERGENCY CONTACTS

Please provide details of 2 people who can be contacted in the case of an emergency

Emergency Contact 1

Emergency contact 2

CONSENT

Photographs

First Aid

Behaviour Code

You can read our Behaviour Code for Participants here

You can read our behaviour Code for Parents/Carers here

Data protection

You can read our Privacy Notice here

You can read our Data Protection Policy here

Communication

DECLARATION AND SIGNATURE OF ACCEPTANCE

Please ensure that you read and sign to accept all of the following:

1. I wish to apply as a participant in the centre's activities and confirm that all details given are accurate to the best of my knowledge. I agree that should a centre coach require additional information about me at any time, I will provide what is required. If required, I am willing to obtain reports from a specialist practitioner who is familiar with my condition and understand that I may be required to pay a fee for such a report.

2. I recognise that activities with horses are a risk sport and I voluntarily accept the risks involved. I further understand the need for the participant or carer to take all reasonable precautions. In the absence of any negligence on the part of the centre, I accept that no liability will attach to them.

3. I will immediately inform the centre of any change in my:
- address, email or contact numbers
- medication or in my mental or physical health condition
- changes to my emergency contact details

4. For the welfare of the centre's horses and ponies, all riders will be weighed on the centre's scales at least once per term in their complete riding clothes. This information will be kept confidential on their rider files and only the centre's staff will have access to this information. This information will only be used for the purpose of allocating a suitable horse or pony.

5. Participants may wish to provide their own riding hat that conforms to valid safety standards (Standards currently include British PAS 015: 2011, European VG1 - provided it is BSI Kitemarked or Inspec IC marked, EN1384-2017 provided it has another accepted standard from this list which is BSI Kitemarked or Inspec IC marked, ASTM F1163 (2004a or 04a) provided it is SEI marked, SNELL E2016). We have a number of hats that may be borrowed but regular participants may wish to have their own hat provided it meets the above standards.

6. If I engage in any behaviour that falls outside the Belvoir Vale RDA Behaviour Agreement, this may result in immediate termination of my sessions without notice.