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
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?*
YesNo
Please provide further info
YesNo
Please provide further info
YesNo
Please provide further info on cognitive impairment
Please tell us of anything else we should be aware of
Walker without aidWalker with aidManual wheelchair userPowerchair user
SeatedStandingNot sure
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
YesNo
YesNo
YesNo
Sun 16 JulyThurs 31 Aug
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
EmailPhonePost
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LimbPower Waterski Taster Application