Equestrian Training Programme Application Form

All information contained in your application will be treated as strictly confidential

Name*

First Last

Address*

Street Address Address Line 2 City \ Town County Postal Code Country

Date of Birth*

Age at Application

PPS Number*

Email*

Enter Email Confirm Email

Mobile Number*

Next of Kin Contact Details

Next of Kin Contact Name

First Last

Next of Kin Contact Phone

Next of Kin Email Address

Next of Kin Address

Street Address Address Line 2 City \ Town County Postal Code Country

Person Making Referral Contact Details

Person Making Referral Name

First Last

Person Making Referral Contact Phone

Person Making Referral Email Address

Person Making Referral Address

Street Address Address Line 2 City \ Town County Postal Code Country

Emergency Contact Details (if different from Next of Kin)

Emergency Contact Name (if different from Next of Kin)

First Last

Emergency Contact Mobile Number (if different from Next of Kin)

Emergency Contact Email Address (if different from Next of Kin)

Emergency Contact Address (if different from Next of Kin)

Street Address Address Line 2 City \ Town County Postal Code Country

Please outline your living circumstances (Living alone, with foster parents, at home with family etc.)

Previous Education

List with dates any schools/other training attended e.g. Exams, QQI Certificates held to date etc.

Dates	School/Training Centre	Awards Received – Please include Junior and Leaving certs results if you have any.

Work Experience/Placements

Work Experience/Placements Details

Dates	Employer/Work Placement	Roles & Responsibilities

Relevant Volunteer Experience (if any):

Health/Other Issues

Name, Address & Phone Number of GP:

Please list current or past medical conditions:

Are you taking medication? Please list all medications:

Have you any allergies, (dust, hay, etc)? Please give details:

Other Relevant Details

How did you hear about our Equestrian Training Programme?

Why would you like to do this course?

Do you have experience of working with horses?

Do you have experience of horse riding?

Do you have any other equine related experience which you feel is relevant to this Application?

Are you in receipt of any social welfare allowance? Please give details including claim number:

Have you any history of criminal convictions or arrests? If yes please give details.

Please include the following documents with application (where possible):

If you cannot attach the files please post them to Jacqueline Joynt, Festina Lente, Old Connaught Avenue, Bray, Co Wicklow, A98F702

Letter from person making referral (where applicable)

Drop files here or

Recent School Report/Reference

Drop files here or

Recent Psychological Report/Assessment

Drop files here or

Any relevant medical reports

Drop files here or

Copies of FETAC/QQI or exam certificates

Drop files here or

How did you hear about Festina Lente?*

Do you give permission for any photos taken by staff to be used for Festina Lente purposes (Website, Social Media etc)?*

Yes
No

I declare to the best of my knowledge that the details given on this form are true and complete. (Please note that omitting relevant information may affect your application.)

Name of Applicant (constitutes a written signature)*

Date

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