Accessible Kayak Experience Request Form
This form is for individuals requesting a free guided experience provided in conjunction with a kayak rental through Two Chix & A Dirty Oar’s accessibility program. This program is available only for kayak experiences and does not apply to private boat charters or other services. No medical documentation is required. Please share only the information you are comfortable providing.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
Please Select
Email
Phone
Text
Have you already booked your kayak rental?
Please Select
Yes
No, not yet
If yes, please provide your booking date below
-
Month
-
Day
Year
Date
Is this request for you or for someone you support?
Please Select
For myself
For someone I support or care for
Participant Age Range
Please Select
Under 6
6-18
18-30
31-50
51-65
65+
Please describe any access needs or accommodations we should be aware of.
Will the participant be attending with a caregiver or support person?
Please Select
Yes
No
If yes, please briefly describe the role of the caregiver or support person.
Experience Type
Guided Kayak Experience (Accessibility Program)
Comfort Level Around Water
Please Select
Very Comfortable
Somewhat Comfortable
Limited Experience
First Time Kayaking
Kayak Rental Acknowledgment
I understand this accessibility program is available only with a kayak rental and does not apply to private boat charters or other services.
Safety Acknowledgment
I understand this is a guided kayak experience subject to weather, water conditions, equipment availability, and safety requirements. A waiver will be required prior to participation.
Is there anything else you’d like us to know to help make this experience safe and enjoyable?
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