LimbPower waterski application

LimbPower Waterski Taster Application

Edge Adaptive Sports Centre, Staines
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.

Some grip/ arm strength is needed to hold the handle, as well as the ability to release the handle. Adaptive harnesses are available to assist upper limb amputees/ impairments.
Full name of participant*

First NameLast Name
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?*
Upper limb loss/ impairment*

YesNo
Please provide further info
Lower limb loss/ impairment*

YesNo
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 provide further info on cognitive impairment
Please tell us of anything else we should be aware of
Mobility*

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

SeatedStandingNot sure
Have you waterskied or wakeboarded before?*

YesNo
If yes, please describe your ability
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?*

YesNo
Do you suffer from epilepsy?*

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

YesNo
Which date would you like to apply for?*

Sun 16 JulyThurs 31 Aug
Would you be interested in optional on-site accommodation? (we will contact you to discuss this)

YesNo
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
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LimbPower Waterski Taster Application