Manitoba Horse Council - Learn to Ride Host Application form

Coordinator Information

This form should be completed by the facility owner, barn manager, coordinator of the evaluation, or the evaluator themselves.

Forms and Fees required for submission by coordinator prior to Evaluator assignment:

Signed Manitoba Horse Council Liability Waiver for each of the candidates (Adult Waiver or Youth Waiver)
Administration Fee(s) to be sent after submitting this form.

You will receive a confirmation by email.

First name *

Last name *

Email *

Mobile

Requested date of evaluation *

Facility Information

Facility Name *

Address *

City *

Country *

State/Province *

Region *

Zip/Postal code *

Facility Contact number *

Purposed Evaluator

First name *

Last name *

Candidate Information

Please use the format 12345/Western/1 below when indicating the candidates information for MHC number/Discipline/Rider level to be evaluated

First name *

Last name *

MHC number/Discipline/Rider level to be evaluated *

Administration Fee

Item

Minor*

Price

$30.00

Amount

$0.00

Adult*

$30.00

$0.00

Subtotal $0.00

*The Quantity refers to the amount of rider level certificates to be issued. For example, if you are evaluating levels 1-3 for a student, but they only wish to receive their level 3 certificate you will put 1 in the Qty box. If they wanted all three certificates you would indicate 3 under Qty.

I agree that as the host conducting evaluations, I will ensure to provide safe facilities, have an emergency action plan in place, and have valid liability insurance and agree to accept full responsibility for this evaluation.

I have read and accept *

Please read and scroll to the bottom to accept.

I agree that by submitting this application, I am electronically signing the application. I, the undersigned, solemnly declare that the information I have provided is true to the best of my knowledge.

I have read and accept *

Please read and scroll to the bottom to accept.

Electronic signature

Please sign your name inside the box

Type your name

Signature style

Electronic signature Signature pad

A required field has not been filled.

Please accept all conditions.

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Email or mobile

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