Application form











Age if under 21:


Are you a member of a Pony Club, EA, HRCAV or similar: _____________________________

Membership no:

Ambulance membership no:


(Please note you MUST have appropriate personal insurance, including ambulance insurance, to handle the ponies or horses). If you are a member of EA, HRCAV or a PC you will automatically have this.


Brief experience with riding or handling horses:







(If none just say none)


Please provide the following information, in case of any emergency:

Name and telephone numbers of contact people:

(Legal guardian details must be provided if rider is under 18.) 

Emergency contact name 

Relationship with rider 

Mobile / Home / Work Phone 

Are there any specific problems where prior discussion might be useful? 




Please indicate what you hope to gain from your session(s). Give as much or as little information as you wish. You can include general and specific queries as well.