Manitoba Horse Council - Learn to Ride Rider level Evaluation Application (Evaluator initiated)

Evaluator Information

This form should be filled out by a current NCCP instructor/coach who will be evaluating students in the Learn to Ride/Drive program.

Additional forms required for submission prior to evaluation:

Signed Manitoba Horse Council Liability Waiver for each of the candidates (Adult Waiver or Youth Waiver)
Administration Fee of $30.00 per rider per certificate to be issued for minors and $31.50 for candidates above 18.

You will receive a confirmation by email.

First name *

Last name *

Email *

Mobile

Facility Information

Facility Name *

Address *

City *

Country *

State/Province *

Region *

Zip/Postal code *

Requested date of evaluation *

Candidate Information

First name *

Last name *

MHC Number & Rider Level to be evaluated (include E for English W for Western or D for Drive). *

Administration fee

Item

Minors to be Evaluated*

Price

$30.00

Amount

$0.00

Adults to be Evaluated*

$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.

Special instructions

If if one rider is only requesting a badge/certificate for their highest level achieved during the evaluation, but another rider is requesting a badge/certificate for each level achieved please indicate below by using the following:

First and last name # of badges

Special instructions

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.

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Electronic signature

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