Awaken 2022 Provision Request Form

Awaken 2025 Provision Request Form

Complete this form if you have any Disabilities/ Specific Medical Requirements that require our support. All forms must be submitted by 31st July 2025 for consideration.
Protecting your data
All data supplied on this form is handled in line with our privacy policy, and as such is held securely, only shared with Ground Level employees with a requirement to access the information and is deleted 1 year after the event has taken place.

All of the information we ask for on this form is to ensure we can put sufficient provision in place for your needs, it's a catch-all form and as such not all of the questions will be relevant to each person who completes it, therefore it's at the applicants discretion what you decide to tell us in the non-mandatory fields. But please be aware that we can only aim to provide provision when we are aware of the relevant needs and requirements. By completing this form you consent to Ground Level holding and processing your data in line with the above statement and relevant policies.

Our privacy policy can be viewed here
General Details

Please complete this section with the details of the person with a Disability/ Specific Medical Requirement.
Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Age at Event (August 2025)*
Venue Attending*
Please tell us which venue you plan on attending for main meetings
Church Attended*
Just in case we need to verify any details with your Church Leader
Church Leader*
Booking Contact

Please complete this section with details of the booking contact
Full Name (If different from above)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
E-mail*
Mobile Number*

Area CodePhone Number
Phone Number

Area CodePhone Number
Are you Camping or Event pass*

CamperEvent
Carer Details

Does the person with a Disability/ specific medical requirement have a carer? if so please tell us below, Free admission is offered for Carers who would not otherwise be attending the event, to book a carer place please contact the office
Carers Name

First NameLast Name
Carers Mobile Number

Area CodePhone Number
Please confirm if your carer is only attending the event due to your disability/ specific medical requirements?

Yes, they are only attending because of my needsNo, they are attending for their own benefit as well

Specific Provision

Awaken is committed to facilitating individuals with disabilities/ specific medical requirements, please list below under the relevant headings any specific provision you require during the event that you think we should be aware of.
Physical & Mobility Needs

Please tell us about any physical or mobility needs you/ the person this is for might have that you think we should be aware of
Physical/ Mobility Needs
Will you be using a mobility aid, wheelchair or any other Specific Equipment?*

YesNo
Do you require a car space next to your camping pitch?*

YesNo
Do you require a Disabled car parking pass?*

YesNo
Please upload a picture of your current valid Disabled Parking Permit

Browse Files

Cancelof
Will you be bringing a guide, assistance or therapy dog with you?*

YesNo

Guide, Assistance or Therapy Dogs

Please tell us if you will be bringing a guide, assistance or therapy dog with you to the event.
Guide and Assistance Dogs should be accredited and trained by a relevant organisation. Therapy Dogs must comply to the following criteria
1. Both the dog and handler should of received accredited training
2. You should hold relevant public liability insurance for the dog
3. The dog must be identifiable by a vest which clearly states 'Therapy Dog'
You will be asked to supply evidence that all this criteria has been met before we can authorise your dog onto site.

Please note that except for Guide, Assistance and Authorised Therapy Dog's we do not allow any other Dog's onto site.
Please Specify*

Guide DogAssistance DogTherapy Dog
Dog Breed*
For Guide and Assistance dogs please state which organisation your dog is accredited with
For Therapy Dog's please confirm you have the relevant provisions in place

Dog handler trainingDog trainingPublic Liability InsuranceIdentification vest
Once you have completed this form please email certificates to admin@groundlevel.org.uk who will then be able to confirm if your dog can be authorised to attend.

Specific Provision - Electric Hook Up
At present Awaken is unable to provide commercial campsite facilites. Electric hook-up provision can only be provided for those with a genuine medical requirement.
Do you require an electric Hook-Up?*

YesNo

Electric Hook-Up Provision
All electric hook-ups are subject to acceptance.

We have a restricted number of facilities for hook-ups and therefore while we try our best to meet your requirements we may not be able to grant or approve every request. Confirmation will be sent to you regarding if your hook-up has been granted or not and then a ticket will be issued.
Please state the reason why you qualify for an Electric Hook-Up

Sensory, Communication & Interaction Needs

Please tell us about any hearing, speech, communication or visual difficulties you/ the person this is for may have that you think we should be aware of
Sensory, Communication & Interaction Needs
Do you require Sign Language?*

Yes - BSLNo
Do you require Large Print Lyrics?*

YesNo
Do you require a Hearing Loop?*

YesNo

Cognition & Learning

Please tell us if you/ the person this is for have difficulties with reading and/or writing that you think we should be aware of; How can you be helped with these? (I.e. Simplified information, One-to-one support e.t.c.)
Cognition & Learning

Behaviour, Social and Emotional Development

If you/ the person this is for has behavioural difficulties you think we should be aware of please state any relevant conditions below
Behaviour, Social & Emotional

Confirmation
In the event of the applicant requiring medical intervention by either a first aider, first responder or paramedic provided by either a qualified member of the venue staff, or external provider it will be assumed that every effort should be taken to preserve life. If however the applicant would prefer such intervention to NOT take place it is requested they carry both a signed do not resuscitate (DNR) form on their person at all times along with a DNR wristband - or other suitable notification that medical intervention should not be administered.
I hereby give permission for First Aid by the venue qualified First Aider to be administered if it is felt that it would jeopardise the safety of myself/ the person this is for to wait for on-site paramedics to arrive.

Yes
Are there any other ways in which you require specific provision or facilities that are not already outlined as provided within the "Provision for disabilities or specific medical requirements" or that you have not already outlined on this form?
I confirm that all of the above information stated is true to the best of my knowledge.*

Yes
Form Completed By*
Relationship to person with Specific Medical Needs and/or Disabilities*

I am the PersonSpouse/ PartnerParent/ GuardianCarerOther
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Awaken 2025 Provision Request Form

Protecting your data

General Details

Booking Contact

Carer Details

Specific Provision

Physical & Mobility Needs

Guide, Assistance or Therapy Dogs

Specific Provision - Electric Hook Up

Electric Hook-Up Provision

Sensory, Communication & Interaction Needs

Cognition & Learning

Behaviour, Social and Emotional Development

Confirmation