Kids watersports day application

Kids Watersports Days

@ Edge Adaptive Sports Centre, Staines
FOR UNDER-18s WITH A DISABILITY

Waterskiing, inflatable rides, paddlesports. Siblings are welcome to join in too!

10am - 4pm. Please see dates below.

Access Adventures aims to be as inclusive as possible, but there are some limitations for each activity to ensure safety. Contact us with any concerns.
Name of under 18 disabled participant*

First NameLast Name
D.O.B.*

DayMonthYear
Date
Gender*

MaleFemale
Name of parent or guardian*

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

Street Address

Street Address Line 2

CityCounty

Postcode
We ask for a donation towards the cost of this camp:

Min £100, max £200 per family.

Includes waterskiing & inflatable rides for the kids, plus lunch for the whole family

Accommodation available on request - £15 per person per night

Food will be available to purchase late afternoon/ early evening

Further info on the disabled under 18 participant:
Please tell us what their primary disability is*
Is their disability acquired or congenital?*

AcquiredCongenital
If acquired, how many years since the accident/ onset?
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 they 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
Mobility:*

WalkerWalker with aidManual wheelchair userPowerchair user
Balance*

1

2

3

4

5

1 is Worst, 5 is Best
Grip*

1

2

3

4

5

1 is Worst, 5 is Best
Ability to follow instruction*

1

2

3

4

5

1 is Worst, 5 is Best
Please tell us of anything else we should be aware of
Would you like to bring an able-bodied sibling to take part in the activities?*

YesNo
If yes, please provide their name

First NameLast Name
If yes, please provide their D.O.B.

DayMonthYear
Date
Are you interested in the overnight accommodation?*

YesNo
How did you hear about us?*
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:

Kids Watersports Days