Adaptive waterski application

Adaptive waterski application

Edge Adaptive Sports Centre, Staines
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 as these are extreme sports there are some limitations to ensure safety.

For waterskiing/ wakeboarding, the 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.

The 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 NameLast Name
Address (optional)

Street Address

Street Address Line 2

CityCounty

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

DayMonthYear
Date
Gender*

MaleFemale
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?*

AcquiredCongenital
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)*

YesNo
Please provide further info on cognitive impairment
Do you have a PA at home for personal care needs?*

YesNo
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 without aidWalker with aidManual wheelchair userPowerchair user
What type of waterskiing do you think you'd prefer?*

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

YesNo
Do you suffer from epilepsy?*

YesNo
Can you swim or float independently in deep water?*

YesNo
Which date(s) would you like to apply for?*

Tues 10 Sept (this session is already full, we can add you to the reserve list)Sat 14 Sept (this session is already full, we can add you to the reserve list)
Name of parent of guardian (leave blank if this does not apply)

First NameLast 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)*

EmailPhonePost
Where did you hear about us?*
Should be Empty: