LWP25 Access Form

The closing date for access applications is Friday 25th July

If you require this form in an alternative format please email

access@livefromwythenshawepark.co.uk

Name of access customer*

First NameLast Name

Email for access customer *

example@example.com

Phone number for access customer

Which event are you applying for access facilities?*

Fontaines D.C. on Friday 15th August

Is the access customer ticket....?

General AdmissionVIP

Access customer ticket reference

Supporting Documents

We require a scan or digital photo of one of the following pieces of evidence:
(We don't need to see detailed health conditions or the amount of benefit you should claim. We advise this to be blanked out.)Supporting documents include:

PIP (Personal Independence Payment) dated in the last 12 months
DLA dated in the last 12 months
Letter from a medical professional, including a doctor’s note or a letter from an occupation therapist
Carer's allowance
A Nimbus Access Card with the +1 symbol. Visit the Access Card page for more information.
Confirmation in writing from Social Services that the individual is included on their Deaf Register, or a letter or report from an aural specialist confirming that hearing loss has been recorded at 70 - 95 dBHL or worse
War Pensions Mobility allowance
Blind or partially sighted registration certificate (BD8 or CVI certificate)
A personal letter from the GP, community nurse or social worker
Benefit award letters
Copy of a blue badge (we would need to see both sides)

Evidence Upload

Please select from the following which accessible facilities you require.

Please note there is limited space for the Accessible Viewing Platform [AVP], therefore we request that it is only requested if elevation is required. There is an Accessible Viewing Area [AVA] in front of the platform, which will provide an area with temporary tracking on the ground and more space for any one who requires it.

Do you require a free companion ticket?*

YesNo

Do you require a a parking space in the Accessible Car Park?*

YesNo

Do you require access to the medical fridge?*

YesNo

Do you require access to Accessible Viewing Platform [AVP]*

YesNo

Do you require access to the Accessible Viewing Area [AVA]*

YesNo

Will you be attending in a manual wheelchair?*

YesNo

Will you be attending in an electric wheelchair?*

YesNo

Any additional comments or requests?

LWP25 Accessibility Request Form