Five Day Residential Program Registration Name(Required) Prefix Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Last Birth date(Required) DD dash MM dash YYYY 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 AfghanistanAlbaniaAlgeriaAmerican 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 RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint 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 TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Which date do you want to attend?(Required) Expression of interest 2025 16-20 June 2025 (Veteran and Defence Personnel Only) 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 hereTravel to Southern Highlands(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 Bowral Train 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 Glamping Teepee(Required)Would you be willing to sleep in a Glamping Teepee erected at the back door of Dixieland Estate? I am willing to be in a Glamping Teepee outside I would have concerns about being outside in a 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.NameThis field is for validation purposes and should be left unchanged. Δ
