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Rider Registration Form
Llangorse Multi Activity Centre, Llangorse, Brecon, LD3 7UH.

Horse Rider’s Code of Conduct

Please read carefully and fully

  • I understand that riding at any standard has inherent risk and that all horses may react unpredictably on occasions.
  • I may fall off and could be injured. I accept that risk.
  • I understand that instructions are given for my safety and agree to follow instructions given to me by staff and instructors of the riding centre. I will not enter any horse area without a member of staff. I will not run, shout or scream while on and around the horses.
  • I understand that wearing an appropriate (current BSI Standard) riding helmet may reduce the severity of an injury should an accident happen and agree that I will always wear a riding helmet whilst on and around the horses. I will also wear suitable footwear when riding.
  • I understand that body protectors are not provided and it is my choice whether or not to supply and wear my own.
  • I understand that for my personal safety, cameras, mobile phones, cigarettes and sharp, hard or bulky objects cannot be carried while riding as they may increase the severity of an injury should an accident happen. Valuables and Jewellery should be locked away and keys left at reception.
  • I understand that the riding centre will make decisions based on information I give them and agree to always be honest and volunteer information about:
    • my abilities and riding experience
    • any previous riding accidents
    • any medical condition(s) which may affect my ability to ride
  • I understand that children are at particular risk around horses and agree that I will keep any children that I am responsible for under close supervision.
  • I understand that the riding centre may refuse my request to ride or alter the activity provided for safety or operational reasons.

RIDING IS A RISK SPORT – Please read carefully before signing:

I have read and fully understand the Llangorse Multi Activity Centre Horse Rider’s Code of Conduct, above. I have received satisfactory answers to any questions I have asked regarding the Horse Rider’s Code of Conduct. If I have any further questions, queries or concerns regarding my voluntary participation in riding at Llangorse Multi Activity Centre, I will raise them with a member of staff or my instructor immediately.

My choice to ride here is voluntary. I understand that riding at any standard has inherent risk and participation holds potential danger, and that all horses may react unpredictably on occasions. I may fall off and could be injured. I accept that risk and agree that Llangorse Multi Activity Centre will not be liable for injury or damage to property unless it is caused by their negligence. I will listen to all instructions given to me by staff and instructors of the centre and pay attention to all practical demonstrations.

I confirm that to the best of my knowledge all the details I have provided on this waiver are correct.

Riders UNDER 16 years of age: Where I am signing on behalf of a minor I have explained the Horse Rider’s Code of Conduct to my child and we both understand and accept the risk and agree that Llangorse Multi Activity Centre will not be liable for injury or damage to property unless it is caused by their negligence.

GDPR / Data Protection Act 2018: Statement: I understand that information I have given will be held in accordance with data protection regulations but may also be made available to Insurers and other concerned parties in the event of an injury or accident.

Today's Date: August 11, 2020

If you are a Parent or Guardian, and your children will be participating in the activity with you, please add them on your form by selecting 'Adult and Minor(s)' below.

For other children, the child's Parent or Guardian will need to complete the form on their behalf. If you are not participating with the children, select 'Minor(s)' below to complete the form for the children only.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to subscribe to our email newsletter
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Your Visit

To ensure your visit goes as smoothly as possible, we need to know when you are coming and who made the booking.

Please note: All bookings must be made in advance. If you have not made a booking, please call us on 01874 658 272 or email enquiry@activityuk.com


When are you coming? *

Who made the booking? (Please enter their name) *

Coronavirus (Covid-19) - Visiting Us Safely

We have new safety measures in place to help protect you, our staff, and our wider community and help prevent the spread of coronavirus. 

To ensure your visit to us is as safe as possible, we ask that all members of your group familiarise themselves with our Covid-19 Customer Pre-Arrival Information. This can be found on our website, www.activityuk.com

Acceptance: *
I have read the Covid-19 Customer Pre-Arrival Information, and agree to follow all safety measures during my visit
Parent(s) or legal guardian(s) must sign for any participating minor (those UNDER 16 years of age) and agree that they and the minor are subject to all the terms of this document, as set out above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Weight *

Height *
Have you or the rider you are signing for, ever suffered serious injury or discomfort while riding or been advised not to ride?*
No
Yes

If Yes, please describe. IF NO, PLEASE LEAVE BLANK.

Please detail ANY disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency. This may include but not be limited to any back problems and any condition, which can affect balance or cause blackouts / loss of consciousness / fitting etc. IF NONE, PLEASE LEAVE BLANK.

RIDING ABILITY / DECLARATION

I consider myself (or the person riding for who I am signing on behalf of as a minor) to be a*
How many times have you / rider ridden in the last 12 months?*
What do you believe yours or the rider's capabilities on a horse or pony to be? Please tick ALL that apply
Riding at a walk
Trotting with stirrups
Trotting without stirrups
Cantering
Galloping
Riding over jumps

If riding over jumps, how high?
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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