Adaptive Form

Adaptive Form

Please give us at least 7 days lead time when booking an adaptive lesson, so we can make sure that we can accommodate you!
How can we support you?

Lesson with equipment and/or volunteerEquipment only, or equipment and volunteerVolunteer only
Name?*

First NameLast Name
Date of Birth?*

DayMonthYear
Date
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Snow Sport New Zealand Membership number
We recognise the extra cost often involved in adaptive snow sports, so we offer some great deals to members of Adaptive Snow Sports NZ, 40% off the lesson price and 50% off rentals and passes amongst others. To become a member, please visit Adaptive Snow Sports Membership » Snow Sports
Name of Caregiver/ Support/ Family member, if applicable

First NameLast Name
Caregiver/ Support/ Family member Email address, if applicable
example@example.com
Caregiver/ Support/ Family member contact number, if applicable

Area CodePhone Number
Do you know what equipment you'd like to use?

YesNo
If yes, please let us know what you'd like to use?
Do you have a preferred discipline? We will try our best to accommodate your choice however this may change once the instructor has made an assessment.*

Stand up SkiingStand up SnowboardingMono SkiBi SkiI am unsure- please advise
Level*

First Time - never tried beforeBeginner - working on stopping and turningNovice - linking turns on green runsIntermediate - skiing or riding blue runsAdvanced - sharpening skills on varied red and black terrain
Please select all that apply to describe your needs.

PhysicalPhysical - wheelchair userCognitiveSensory
Physical

Walking unaided with some weakness or coordination issuesWalking while aidedSingle leg below knee prosthetic userAbove knee prosthetic usersDouble prosthetic user
Physical - Wheelchair user

Wheelchair user looking to have some fun with snow sportsLimited mobility wheelchair userCoordinated and strong upper body wheel chair user.Wheelchair user with limited upper body coordination and weakness
Weight and height of wheelchair user
Cognitive

Verbal communicatorNon verbal communicatorMinimal to no communication
Please let us know a few more details about the person taking the lesson so our team can offer best support. Is there anything to be aware of regarding communication? Any specific behavioural traits? Are there any motivations or triggers
Sensory

Visually impaired- No visionVisually impaired- Partial visionDeaf/Hard of hearing
The above options are guidelines. Please let us know any other information about your ability.*
Relevant Medical Information
Have you already purchased your lesson?

YesNo
Booking reference number
CT012345 or 20215641
First lesson day*

DayMonthYear
Add additional dates in "Additional Information" section
Additional Information
Please add any additional dates/ requirements here
Time and Duration of lesson. Please note, below times are the meeting times with the instructor. For any first timer lessons requiring equipment, we recommend at least a 3 hour lesson, as the initial set up will take some time.*

1hr at 9am (not suitable for sit ski lessons)1.5hrs at 9am (not suitable for sit ski lessons)2hrs at 9am2hrs at 11am2hrs at 1:30pm3hrs at 9am3hrs at 12:30pm6hrs at 9amOther
Instructor to request, if applicable
Equipment required*

Ski/ Snowboard rentalOutrigger rentalSit ski rentalLinks and tethersHeadset/ IntercomI don't require any rentalI am unsure - please advise
I would like to add on a ski pass/ ski passes*

YesNo
Dates for ski passes, if applicable
On-snow support volunteers required*

YesNo
Do you agree to be contacted by the instructor assigned to your lesson before your lesson?

YesNo
Which dates and times are you planning on visiting us?*
Should be Empty: