Five Day Residential Program Registration Δ PhoneThis field is for validation purposes and should be left unchanged.Name(Required) Prefix Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Last Birth date(Required) GenderTo which gender identity do you most identifyFemaleMaleTransgender FemaleTransgender MaleGender Variant / Non-confirmingNot listedPrefer not to answerEmail(Required) Mobile(Required)Residential address(Required) Street Address Address Line 2 City State / Province / Region Postcode Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Which date do you want to attend?(Required) Expression of interest 21-25 September 2026 Previous program attendance(Required)Have you been to any of the Horse Aid or TVWA programs before? No, I haven't been to any previous programs Yes, I have been to a previous programs Details of previous program(Required)If you select "Yes" please provide details of the approximate date and location of the program and was it a One Day or Residential Program?Which of the following applies to you(Required) I am a military veteran I am serving defence personnel I am serving first responder I am ex-serving first responder Other - please specify below Details of service(Required)If you have served or are serving, please provide details of your service and (if applicable) your exit.Other - please specify(Required)If you have selected "Other", please specify the basis on which you are registering your interest in the programPlease provide some detail of your reason for selecting a Horse Aid program(Required)Emergency contact name(Required) Prefix Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Last Emergency contact relationship(Required)Emergency contact mobile(Required)Emergency contact email(Required) Dietary requirements(Required) No, I don't have any dietary requirements Yes, I do have dietary requirements (detail below) Detail of your dietary requirements(Required)Provide information about your dietary requirements herePhysical Capacity(Required)We learn horsemanship skills on the ground with no riding. Are you able-bodied to respond to instructions to move quickly and in sand in a round yard? If you have an injury we will be in contact to determine if the round yard is suitable / safe for you. Yes, I am able-bodied No, I have an injury that may make this difficult Travel to Helensburgh, NSW(Required)Do you need assistance travelling to the venue? No, I will make my own way Yes, I am happy to carpool (if possible) Yes, I can be picked up from Helensburgh Station Sharing a room(Required)In order to include the maximum possible participants we may ask you to share a room with someone of the same gender, is there any reason this would not suit? No, I don't mind sharing a room with someone of the same gender. Yes, this would be a concern for me. Staying in Caravan / Glamping Teepee(Required)Would you be willing to sleep in a Caravan / Glamping Teepee? I am willing to be in a Caravan / Glamping Teepee I would have concerns about being outside in a Caravan / Glamping Teepee Please explain your concern with sharing a room with same gender?(Required)Civilian participants(Required)In some limited instances we have civilians come on the program either as carers or for other specific circumstances That would be fine - being with civilians is part of life I would have a problem doing a program with civilians Assistance during the week(Required)Are you happy to help with food prep/packup, horse feeding, fire making? Yes No How did you hear about us?(Required)Please provide some details of how you heard about us. And if you are referred by a carer, psychologist or other professional we would welcome contact details so we can further discuss our programs with those who are willing to recommend us.Consent to communications I consent to receiving program updates, special offers, news and other marketing material from Horse Aid.
