Land kiting application

Adaptive land kiting

@ Pool, Dorset
For adults with a physical disability

Wed 16 July

Please be aware that kiting is a very weather dependent sport! We will be unable to run the session if there is not enough wind, or if the wind is too strong.
Name*

First NameLast Name
Email*
example@example.com
Phone number*
Address (optional)

Street Address

Street Address Line 2

CityCounty

Postcode
D.O.B.*

DayMonthYear
Date
Gender*

MaleFemale
Suggested donation towards this camp:

£30 (subsidised) - £40 (actual cost)

Includes kite equipment, coaching & lunch
Please tell us what your primary disability is*
Is your disability acquired or congenital?*

AcquiredCongenital
If spinal cord injury, please provide further info
Level of SCI
If spinal cord injury, please provide further info

CompleteIncomplete
If other disability, please provide further info
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 describe any cognitive impairment
Please tell us of anything else we should be aware of
Mobility:*

WalkerWalker with aidManual wheelchair userPowerchair user
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
We would like to contact you with information about our services. This may include details on camps, volunteer opportunities, how you can donate, fundraising events. 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 (mark ALL methods you would be happy with)*

EmailPhonePost
Should be Empty:

Adaptive land kiting