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WIRS Form

[et_pb_section fb_built=”1″ _builder_version=”3.22.3″][et_pb_row _builder_version=”3.25″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”][et_pb_column type=”4_4″ _builder_version=”3.0.47″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_contact_form _builder_version=”3.25.3″ z_index_tablet=”500″ title_text_shadow_horizontal_length_tablet=”0px” title_text_shadow_vertical_length_tablet=”0px” title_text_shadow_blur_strength_tablet=”1px” captcha_text_shadow_horizontal_length_tablet=”0px” captcha_text_shadow_vertical_length_tablet=”0px” captcha_text_shadow_blur_strength_tablet=”1px” form_field_text_shadow_horizontal_length_tablet=”0px” form_field_text_shadow_vertical_length_tablet=”0px” form_field_text_shadow_blur_strength_tablet=”1px” button_text_shadow_horizontal_length_tablet=”0px” button_text_shadow_vertical_length_tablet=”0px” button_text_shadow_blur_strength_tablet=”1px” box_shadow_horizontal_tablet=”0px” box_shadow_vertical_tablet=”0px” box_shadow_blur_tablet=”40px” box_shadow_spread_tablet=”0px” box_shadow_horizontal_button_tablet=”0px” box_shadow_vertical_button_tablet=”0px” box_shadow_blur_button_tablet=”40px” box_shadow_spread_button_tablet=”0px” text_shadow_horizontal_length_tablet=”0px” text_shadow_vertical_length_tablet=”0px” text_shadow_blur_strength_tablet=”1px”][et_pb_contact_field field_id=”Are_you_checking_in” field_title=”Are you checking in…” field_type=”select” select_options=”%91{%22value%22:%22One Person%22,%22checked%22:0},{%22value%22:%22Couple%22,%22checked%22:0},{%22value%22:%22Family%22,%22checked%22:0},{%22value%22:%22Friends/Group%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”Weight” field_title=”Weight (kgs)” allowed_symbols=”numbers” _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”Rider_name” field_title=”Please enter in your full name” _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”hearabout” field_title=”Where did you hear about us?” field_type=”select” select_options=”%91{%22value%22:%22Brochure%22,%22checked%22:0},{%22value%22:%22Our website%22,%22checked%22:0},{%22value%22:%22Information Centre%22,%22checked%22:0},{%22value%22:%22Walked past%22,%22checked%22:0},{%22value%22:%22Recommended%22,%22checked%22:0},{%22value%22:%22Accommodation/Concierge%22,%22checked%22:0},{%22value%22:%22Internet search%22,%22checked%22:0},{%22value%22:%22Trip Advisor%22,%22checked%22:0},{%22value%22:%22Facebook%22,%22checked%22:0},{%22value%22:%22Other%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”birth_date” field_title=”Date of birth” _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”newslettersignup” field_title=”Would you like to be kept informed about our lessons and riding lessons?” field_type=”radio” radio_options=”%91{%22value%22:%22Yes%22,%22checked%22:0},{%22value%22:%22No%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”gender” field_title=”Gender” field_type=”radio” radio_options=”%91{%22value%22:%22Male%22,%22checked%22:0},{%22value%22:%22Female%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”discomfortinjury_2″ field_title=”Have you ever suffered serious injury or discomfort whilst riding?” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22No%22,%22checked%22:0},{%22value%22:%22Yes%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”address” field_title=”Address” field_type=”text” _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”discomfortinjury” field_title=”Please detail any disability or medical conditions that may affect your ability to ride or which your instructor should be aware of in case of emergency (e.g. Back problems, diabetes, epilepsy). You may be asked not to ride if we feel it would be of significant risk to yourself, the horse or other riders.” field_type=”text” conditional_logic=”on” conditional_logic_rules=”%91{%22field%22:%22discomfortinjury_2%22,%22condition%22:%22is%22,%22value%22:%22Yes%22}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”phone” field_title=”Phone number” allowed_symbols=”numbers” _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”RiderHeight” field_title=”Height (cms)” allowed_symbols=”numbers” _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”Occupation” field_title=”Occupation” _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”emergencycontact_name” field_title=”Emergency Contact Name” _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”Emergencyno” field_title=”Emergency Contact Number” allowed_symbols=”numbers” _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”RiderExperience” field_title=”How experienced are you?” field_type=”select” select_options=”%91{%22value%22:%22Beginner%22,%22checked%22:0},{%22value%22:%22Novice%22,%22checked%22:0},{%22value%22:%22Intermediate%22,%22checked%22:0},{%22value%22:%22Advanced%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”ridden” field_title=”How many times have you ridden in the last 12 months?” field_type=”select” select_options=”%91{%22value%22:%22Less than 5%22,%22checked%22:0},{%22value%22:%225-20%22,%22checked%22:0},{%22value%22:%22+20%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”RidingCapabilities” field_title=”What do you believe your riding capabilities on a horse / pony to be?” field_type=”select” select_options=”%91{%22value%22:%22Riding at walk%22,%22checked%22:0},{%22value%22:%22Trotting with stirrups%22,%22checked%22:0},{%22value%22:%22Trotting without stirrups%22,%22checked%22:0},{%22value%22:%22Cantering%22,%22checked%22:0},{%22value%22:%22Hacking%22,%22checked%22:0},{%22value%22:%22Jump up to 0.5m%22,%22checked%22:0},{%22value%22:%22Jump up to 0.75%22,%22checked%22:0},{%22value%22:%22x-Country jumps%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”Feel” field_title=”Do you feel…” field_type=”select” select_options=”%91{%22value%22:%22Nervous%22,%22checked%22:0},{%22value%22:%22Ok%22,%22checked%22:0},{%22value%22:%22Confident%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”tcs” field_title=”Please agree to our terms and conditions” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22I agree to the terms and conditions%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][et_pb_contact_field field_id=”Fireexits” field_title=”Please make note of fire exits and assembly points” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22I have noted the fire exits and assembly point%22,%22checked%22:0}%93″ _builder_version=”3.25.3″][/et_pb_contact_field][/et_pb_contact_form][/et_pb_column][/et_pb_row][/et_pb_section]

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