Adaptive waterski application

Adaptive waterski application

Edge Adaptive Sports Centre, Staines
These sessions are now full, but please complete the form to be added to the reserve list or contacted if we add more sessions to the schedule.

We can support beginner/ assisted waterskiers. The information on this form will help us set you up with the most appropriate adaptive equipment/ teaching technique.

Access Adventures tries to be as inclusive as possible, but there are some limitations to ensure safety.

For waterskiing/ wakeboarding, a participant requires some grip/ arm strength to hold the handle, as well as the ability to release the handle. Adaptive harnesses which assist with weak grip/ arm strength are available.

A participant should also have the ability to follow simple instruction.

Costs are subsidised for disabled skiers:

£15 for a 10-15 minute ski set

(or £12 per set for British Waterski disabled members).

Pay by cash or card on the day.

Various dates throughout the summer.
Full name of participant *

First Name Last Name
Address (optional)

Street Address

Street Address Line 2

City County

Postcode
Phone number *
Email *
example@example.com
D.O.B *

Day Month Year
Date
Gender *

Male Female
Please answer the questions below regarding your disability, so we can make sure we are able to support you safely
What is your primary disability? *
Is your disability acquired or congenital? *

Acquired Congenital
Do you have a cognitive impairment? (this can mean when a person has trouble remembering, learning new things, concentrating, communicating, or making decisions that affect their everyday life) *

Yes No
Please provide further info on cognitive impairment
Balance *

1

2

3

4

5

1 is Worst, 5 is Best
Upper body strength *

1

2

3

4

5

1 is Worst, 5 is Best
Grip *

1

2

3

4

5

1 is Worst, 5 is Best
How easy is it to sit independently without support? *

1

2

3

4

5

1 is Worst, 5 is Best
Please list any medication you take regularly
Please tell us of anything else we should be aware of
Mobility *

Walker Walker with aid Manual wheelchair user Powerchair user
What type of skiing do you think you'd prefer? *

Seated Standing Not sure
Weight (although there is not an official weight limit, we might contact you if we have concerns about available equipment or instructor abilities) *
Weight
Do you suffer from asthma? *

Yes No
Do you suffer from epilepsy? *

Yes No
Can you swim or float independently in deep water? *

Yes No
Name of parent of guardian (leave blank if this does not apply)

First Name Last Name
I hereby certify that the information given is correct to the best of my knowledge. Waterskiing and associated tow sports can be dangerous. By signing digitally below, I assume any risk of harm or injury which might occur to the participant due to participation in the event or activity. I release Access Adventures from all liability, costs and damages which might arise from participation in the activity.
Signature of participant or parent/ guardian *

Clear
We would like to contact you with information about our services. This may include details on events, volunteering, fundraising. We won't share your information with others without your permission, except in an emergency. Your data will be used and stored in accordance with the 'General Data Protection Regulation 2018' Please refer to our website for our full privacy policy
Please DO contact me by (please mark ALL methods you would be happy with) *

Email Phone Post
Should be Empty: