About You Title - Select - Adv. (Advocate) Architect Dr. (Doctor) Engr. (Engineer) Esq. (Esquire) Madam Master Miss Mr. Mrs. Ms. Mx. Pharmacist Professor Sir Your Name Your Last Name Your Email Address Your Phone Number? Address (Line 01) Address (Line 02) City State / Province Zip / Postal Country - None - Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua & Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Ceuta & Melilla Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo - Brazzaville Congo - Kinshasa Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d’Ivoire Denmark Diego Garcia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard & McDonald Islands Honduras Hong Kong SAR China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR China Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Outlying Oceania Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Samoa San Marino Sark Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Barthélemy St. Helena St. Kitts & Nevis St. Lucia St. Martin St. Pierre & Miquelon St. Vincent & Grenadines Sudan Suriname Svalbard & Jan Mayen Sweden Switzerland Syria São Tomé & Príncipe Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad & Tobago Tristan da Cunha Tunisia Turkmenistan Turks & Caicos Islands Tuvalu Türkiye U.S. Outlying Islands U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis & Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Your Website What is your current job / profession? Are you a member of any Professional bodies or Accrediting Organisations? Yes No Do you have a business name to place on invoices? Yes No Please list your memberships to Professional Bodies or Accrediting Organisations Registered Company Name Address (Line 01) Address (Line 02) City State / Province Zip / Postal Country - Select - Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua & Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Ceuta & Melilla Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo - Brazzaville Congo - Kinshasa Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d’Ivoire Denmark Diego Garcia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard & McDonald Islands Honduras Hong Kong SAR China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR China Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Outlying Oceania Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Samoa San Marino Sark Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Barthélemy St. Helena St. Kitts & Nevis St. Lucia St. Martin St. Pierre & Miquelon St. Vincent & Grenadines Sudan Suriname Svalbard & Jan Mayen Sweden Switzerland Syria São Tomé & Príncipe Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad & Tobago Tristan da Cunha Tunisia Turkmenistan Turks & Caicos Islands Tuvalu Türkiye U.S. Outlying Islands U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis & Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Do you have any dietary requirements or allergies that we need to be aware of? Yes No Not Applicable Please list any dietary requirements or allergies Course Information Which course are you applying for? - None - Level 2 Certificate (£1899) Level 4 Diploma (£2489) Level 5 Diploma (£1989) Level 7 Certificate (£1989) Please tell us about your interest in applying for our Level 2 Certificate or Level 4 Diploma, and how you envisage using the certificate / diploma in the future Which course date(s) are you interested in? EAS Foundation Certificate – UK • 04 September 2025 EAS Foundation Certificate – Ireland • 25 September 2025 EAS Foundation Certificate – Online • 15 October 2025 EAS Foundation Certificate – Online • 04 February 2026 EAS Foundation Certificate – Essex UK • 09 April 2026 EAS Foundation Certificate – Online • 20 May 2026 EAS Foundation Certificate – Warwickshire UK • 28 May 2026 EAS Foundation Certificate – UK • 23 July 2026 EAS Foundation Certificate – Ireland • 24 September 2026 EAS Foundation Certificate – Northern Ireland • 01 October 2026 Previous experience or interest in Equine Assisted Services Have you ever been involved with Equine Assisted Services? Yes No Have you ever worked as an EAS Practitioner Yes No How have you been involved in Equine Assisted Services? Was it as a practitioner or participant? With which organisation(s), and with what client groupnhave you worked as an EAS practitioner? Have you already recieved training or completed a qualification? Yes No Who was the training / qualification with, and to what level? Is there anything else you would like to share with us to support your application? Emergency Contact Emergency Contact Name Emergency Contact Last Name Emergency Contact Phone Number? Sign-Off I would like to submit my application to Athena Herd Foundation CIC for consideration and approval. I understand that if my application for the next cohort is accepted, I will be required to pay the advised non-refundable deposit to secure my place. By paying this deposit you will be deemed to have accepted the terms and conditions set out on our website athenaherd.org I Agree Would you like to recieve a copy of your application? Yes No Date of Application
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