Referrals

Organisation / Relationship to Person Being Referred

INDIVIDUAL PARTICIPANT / GROUP DETAILS

Full Name of Person / Group Name

If Under 18 or Organising a Group

Parent / Guardian / Group Organiser Name

Relationship to Person / Group

Do you have authority to sign for the minor and/or on behalf of the group?

Yes No

Reason for Referral (Select all that apply)

RIDER DETAILS (For Individual and/or Group Riding Lessons / Clinics Only)

Rider(s) Approximate Height Range

Rider(s) Approximate Weight Range

Rider(s) Lowest Level of Riding Experience (For Groups Only)

Rider(s) Highest Level of Riding Experience

What kind of rider would you describe yourself as?

Confident OK, though I need lots of reassurance I need a lot of reassurance — I'm a Nervous Rider I'm OK to do most things on my own, but may need guidance every now and then

Reigning Downs' first priority is to ensure the highest levels of safety are upheld whilst sessions are in progress. To maintain a safe environment, all new participants will undergo Site Orientation as well as signing a waiver and disclaimer. Additionally, for the comfort and safety of the horses, Reiging Downs has a weight limit for riders. Please do not be offended if we ask to weigh you - this is to ensure that you are matched to the right horse to avoid injury to the animals and maintain a comfortable and safe seating position in the saddle. As part of our official intake and orientation, riders will be weighed and measured to assist with profiling rider to horse. We thank you in advance for your understanding and are happy to discuss any concerns that you may have further in person.

I Accept I Do Not Accept

We collect personal information from you, including information about your name contact information interactions with us billing or purchase information General Health Information. We collect your personal information in order to ensure our programs meet your unique needs and are suited to your requirements. Providing some information is optional. If you choose not to enter basic health and background information, we'll be unable to provide you with a tailored program until we complete a full assessment in person. We keep your information safe by storing it in a secure platform and only allowing certain staff to access it. We keep your information for seven years at which point we securely destroy it by securely erasing all data. You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong. If you’d like to ask for a copy of your information, or to have it corrected, please contact us at jade@reigningdowns.nz, or 021 588 338, or 53 Minerva Road, Makarewa, Invercargill, 9876.

I Accept I Do Not Accept

Do you give permission for photos/video to be taken and used for promotional purposes?

Yes, I give permission No, I do not give permission

I acknowledge the inherent risks of equine activities and voluntarily consent to participate, releasing Reigning Downs Hauora Centre from liability for any injury sustained.

I Accept I Do Not Accept

Reigning Downs Hauora Centre delivers all programs under qualified supervision and cannot be held liable for unforeseen incidents occurring during participation.

I Accept I Do Not Accept

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