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 *

State/Province *

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). *

+ Add

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

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

A required field has not been filled.

Please accept all conditions.

Connect to fill this form

Please type in your email or mobile number. We will send you a connection code.

Submit

Connect

Send again

Waitlist

Leave us your coordinates. We will contact you when a spot frees up.

Please wait...

No Yes

Membership

Your membership is tied to your email address. If you are using the wrong email, your membership will not be detected. You can try disconnecting and connecting using another email address.

If you need further assistance, please write to info@activitymessenger.com. Please include a screen capture if possible.

MANITOBA HORSE COUNCIL 204-925-5719

manitobahorsecouncil.ca mhc.admin@sportmanitoba.ca