Thursday May 6, 2021
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Participant Consent Form

Radnor and West Pony Club Participant Consent Form (version 2)

To prevent the spread of Coronavirus and reduce the risk of exposure to Members, Coaches and families please complete the following form before attending rallies, training or events.

Members name: ………………………………………….

Parent/Carer’s Name……………………………………………………………………..

These measures are necessary to minimise the risk of the spread of infection and need to be observed by everyone. *N.B. We are fully reliant on all members and parents/supporting adults being observant of the current government guidance and regulations, in regard to Covid 19 social distancing measures, hygiene and taking personal responsibility for ensuring that these are followed. Breaches of the guidance and regulations may result in us having to suspend our rallies, training or events in order to safeguard the welfare of members, coaches their families and the wider community. *Please refer to the Covid 19 Risk Assessment for full details.

In preparation for getting started after lockdown (The Radnor and West Hereford Pony Club) has ensured that all hard surfaces and equipment have been sanitised.

Signs will be displayed on site to remind everyone of the need for social distancing and to follow thorough hygiene regimes.

Supplies of sufficient soap/sanitising products and disposable gloves, and hand towels to will be available to allow regular hand washing.

By  signing this form, you are confirming that you are not considered to be clinically extremely vulnerable, acknowledging that (the Radnor and West Hereford Pony Club) has taken all reasonable steps to reduce the risk of Covid-19 and agree to the following protocols:

  • You will ensure that you are not displaying any Covid symptoms requiring self-isolation. i.e. high temperature or a new persistent cough, or living with anyone presenting these symptoms.
  • If symptoms are evident, for you or anyone in the household you will contact the Radnor and West Hereford Pony club to let them know that you will stay at home in line with government guidelines.
  • You will thoroughly sanitise your hands-on arrival and avoid touching surfaces wherever possible.
  • You will endeavour to follow standard social distancing at all times.


  • If you fall ill, or display any symptoms during your visit, you will advise the committee member supervising the rally, training or event and then return home immediately, avoiding touching anything where possible and follow advice of self-isolation.


In order to comply with Track and Trace protocols the Radnor and West Hereford Pony Club will be completing a register at all rallies, training and events detailing all members attending, supporting adults/accompanying persons and arrival and departure times, by signing this consent form you are indicating your consent for this information to be gathered. We ask that accompanying person/s are kept to a minimum and that social distancing is observed during travel to rallies training and events until we have a further relaxation of the Government Guidelines.





Participant/parent/legal guardian Date

If consent has been given by the participant’s parent or legal guardian:



Relationship to participant