Equestrian Safety Rules Form
Please provide the rider and horse details needed to review and follow stable safety rules before participating in riding activities.
Rider Information
Rider full name
*
First Name
Middle Name
Last Name
Date of birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Riding level
*
Beginner
Intermediate
Advanced
Instructor
Other
Emergency contact name
First Name
Middle Name
Last Name
Emergency contact phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Horse and Riding Context
Horse Name
Horse Source
*
Own horse
Facility horse
Shared horse
Other
Riding Activity Type
*
Trail ride
Lesson
Arena work
Jumping
Groundwork
Other
Horse Behavior or Handling Concerns
Safety Gear and Readiness
Helmet use
*
Properly fitted and secured
Available but not being worn
Not available
Boots or footwear type
*
Please Select
Approved riding boots
Sturdy closed-toe shoes
Athletic shoes
Other
Not available
Body protector
Wearing an approved body protector
Available if required
Not applicable for this activity
Not available
Safety gear understanding confirmation
*
I understand the required safety gear for this activity
I will follow staff instructions regarding safety gear
I need clarification on safety gear requirements
Health, Ability, and Restrictions
Riding Restrictions
None
No jumping
No galloping
Light riding only
No trail rides
Other
Recent Injuries or Physical Limitations
Fear Triggers or Safety Concerns
Accommodations or Supervision Needed
Closer supervision
Mounted assistance
Shorter sessions
Frequent breaks
Adaptive equipment
Emergency contact review
Other
Safety Rules Acknowledgment
Signature
*
Submit
Submit
Should be Empty: