Special assistance & mobility aid request

Special assistance & mobility aid request

In order to ensure that you are provided with the level of assistance required, please complete the special assistance form below no later than 48 hours before your departure date. A member of the team will contact you once your request has been received.
Section 1 - Flight and Passenger Details
Passenger Name *

First Name Last Name
Booking Reference *
These usually start A0
Telephone Number *
Please include any dialling or regional codes
Email *
example@example.com
Type of journey *

One way Return
Outbound Flight Number *
Can be found on your booking confirmation
Outbound Flight Date *

Day Month Year
Date of departure
Return Flight Number *
Can be found on your booking confirmation
Return Flight Date *

Day Month Year
Date of return
I require assistance from the check in desk, to the bottom of the aircraft steps. (Passenger must be to walk up the aircraft steps) *

YES NO
I require assistance from the check in desk, to the top of the aircraft steps; carried/lifted onboard. (Not available on a Jetstream 41 aircraft) *

YES NO
I require assistance from the check in desk, to my seat onboard the aircraft; carried/lifted onboard. (Not available on a Jetstream 41 aircraft) *

YES NO
I have a sight impairment. *

YES NO
I wish to take a registered guide dog. *

YES NO
I have a hearing impairment. *

YES NO
I require general assistance due to a hidden disability or travelling with a young child/infant/elderly. *

YES NO
Please detail further: *
I wish to take my own mobility aid. *

YES NO
Section 2 - Reduced mobility aid information
Mobility aid type *
eg. wheelchair, scooter, walking stick etc
Manufacturer
Make
Model
Battery Type
eg. Dry cell, gel cell, lithium-ion (we do not accept wet cell)

Weight of chair of scooter (kg)
Please consult your user guide if unknown

Can the chair/scooter be broken down?

Yes No
Are you able to break your chair/scooter down by yourself?

Yes No
Can you provide instructions to the airport staff?

Yes No
Can the battery be removed?

Yes No

Weight of the heaviest part that can be seperated once dismantled (kg)
Date completed *

Day Month Year
Date
Hour Minutes AM/PM Option
Type name *
Signature *

Clear
Should be Empty:

	cm	inches
Length
Width
Height

	cm	inches
Front Tyre(s)
Rear Tyre(s)

	cm	inches
Length
Width
Height

Special assistance & mobility aid request

Section 1 - Flight and Passenger Details

Section 2 - Reduced mobility aid information