Health Declaration - Horse Riding Holidays and Safaris

Your Name*

First Last

Email*

Do you have any of the following medical conditions?*

Please outline in further detail if you have any of the medical conditions outlined above.*

Enter N/A if you have selected "None of the above"

Have you ever been advised not to ride by a Health Professional?*

Yes
No

Please detail the reason below if you have ever been advised not to ride by a Health Professional.

Please provide details if you have suffered other serious injuries, operations and illness that have required time in hospital or more than a week off riding.

List the year and the injuries, operation and/or illness.

Have you had any episodes of head injury and/or concussion that have required an absence from riding?

Yes
No

If yes, please list the approximate number of episodes.

List the years the injuries occurred in.

Have you had any episodes of head injury and/or concussion in the past two years?

Yes
No

If yes, please provide details.

Declaration*

I declare that all information provided in this health declaration form is true. If any of the circumstances change between the time I have submitted this health declaration form and the commencement of the ride, I will notify the change to Globetrotting immediately.

YES