Therapeutic Riding Coaching Programme Application Form

Name*

First Last

Address*

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

Email*

Enter Email Confirm Email

Mobile Number*

Gender*

PPS Number \ UK National Insurance Number*

Date of Birth*

What is your main interest in participating in this Training Programme?

Please outline your interest and if appropriate your experience in working with people with special needs:

Please outline your experience in teaching/coaching/instructing:

Do you hold a current First Aid\CPR Certificate? If so please give details

Please tell us how you would envisage using the skills and knowledge you will gain from this Training Programme:

Please provide some information as to why you feel you would be a good candidate for this course:

Do you have any Learning difficulties for which you need support if you are undertaking this programme? If yes please list details

Emergency Contact Details

Emergency Contact Name*

First Last

Emergency Contact Phone*

Emergency Contact Address*

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

Equine & Horseriding Experience

What Horse riding\Horsemanship qualifications do you hold, e.g. BHS 2, Pony Club C, others?

Number of years of horse riding experience:

Do you own or have owned a horse/ horses?

Do you take regular horse riding lessons?

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

Do you have access to an equestrian facility? If yes please outline contact details:

If you answered "yes", does the Facility have the following: (please tick):

Current Equestrian Centre or Riding School Insurance
An Arena (preferably indoor)
Mounting block/ Ramp or hoist
Riding Helmets
Safety Stirrups
Back protectors
Wheelchair accessibility
Waiver forms
At least 2 to 3 horses with different body types, back shapes and movement

Is the facility a member of the Association of Irish Riding Establishments (AIRE)?

Qualifications & Experience

Please list all your qualifications:*

Currently Employed?*

Name of Current \ Last Employer*

Date Employment Commenced

Date Employment Finished

Please provide details of current employment and relevant work experience (if any):

Broad outline of responsibilities:

Relevant Work Experience (if any):

Reference One:

Name

First Last

Address

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

Phone*

Email

Reference Two:

Name

First Last

Address

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

Phone*

Email

Please enclose copies of all certificates, as one zip file, referred to in this Application Form:

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

Would you like to join our mailing list?

Yes
No

DECLARATION: I confirm that all information supplied by me in this Application Form is true and correct and if in the event that I do not hold a current First Aid Certificate I will undertake to complete such a course during the first three months of the programme.

The following entry requirements apply:

* 21 years of age or over

* A current First Aid Certificate or a commitment to complete a suitable course during the first three months of the programme.

* Relevant experience of teaching/coaching and instructing.

* BHS stage 2 or Pony Club B or equivalent experience.

* Proven experience/interest in working with people with special needs.

* Participants must confirm that they access to a stable yard/facility in which to practice between Modules Accreditation.

I agree to abide by the above Declaration.*

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Therapeutic Riding Coaching Programme Application Form

Emergency Contact Details

Equine & Horseriding Experience

Qualifications & Experience

Reference One:

Reference Two:

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