Academy Ridden Registration

Personal Details

First Name *

Surname *

Address *

Town/City *

County *

Postcode *

Telephone

Mobile

Email Address *

Date of Birth *

Age *

Height

Weight

Any additional needs/diagnosis we should be aware of to ensure we can provide appropriate support?

What is the main reason for wanting to attend sessions at Tutsham Academy?

Please give details of ANY disability or medical condition that may affect your ability to partake in any farm or equestrian related activities. We are a working farm and safety is paramount.

Funding Information

Funded by: *Family/CarersSchool ProvisionExternal Provision

Invoice details, including email address for financial department *

Funding Consent *I agree that fees will be invoiced termly in advance and understand that missed sessions will still need to be paid for.

Emergency Contact Details

First Name *

Surname *

Relationship to Rider *

Contact Number *

First Name *

Surname *

Relationship to Rider *

Contact Number *

Name of GP *

Telephone Number *

Surgery Address *

Disclaimer

Declaration

Team Tutsham will do everything to ensure the safety and wellbeing of anyone vising or working at the farm. It is a live farm so there are hazards such as machinery, uneven ground, slippery conditions and hazardous substances. The animals themselves can present a risk if not handled correctly under instruction. Safety is paramount and if we feel that we are unable to keep you safe for whatever reason, we may ask that you don’t attend the sessions.

Children under 16 years of age:

I accept full responsibility for the child named overleaf and confirm that he/she rides and handles the animals at his/her own risk. If Team Tutsham are unable to keep the child safe then we may no longer be able to support the child.

Young People aged 16 years and over:

I confirm that I ride and handle the animals at entirely my own risk. If am acting in a way that is unsafe around the farm and animals, I understand I may no longer have access to the provision.

Data Protection Act 1998 Statement

I understand that the information I have given will be held in accordance with the Data Protection Act 1998, but may also be made available to insurers and other concerned pares in the event of any injury or accident. I understand that I must obey the instructor/s and must comply with the Health and Safety requirements of the establishment. I reserve the right not to ride a horse/pony allocated to me or my child and/or request a change of instructor. I acknowledge that RIDING IS A RISK SPORT AND HOLDS POTENTIAL DANGER, and that all horses/ponies may react unpredictably on occasion. Should the necessity arise, I agree to the person in charge giving consent on my behalf for an anaesthetic to be administered or for any other urgent medical treatment to be given.

Consent *I have read and agreed to the data in this form

Full Name *

Relationship to Rider (if required)

Date *

PLEASE SEND ANY EHCP OR BEHAVIOUR PLANS DIRECTLY TO hello@teamtutsham.co.uk

Signature

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Academy Ridden Registration

Personal Details

Funding Information

Emergency Contact Details

Disclaimer

Make a Donation

Visitor Information