Clone of Raphael Registration Form

Raphael Registration Form 2026

Please use this form to register your interest to join the Raphael Pilgrimage to Lourdes. Once you have completed this form we will contact you with information on how to confirm your place with our tour company Tangney Tours.
Thank you for expressing an interest in joining Raphael Pilgrimage to Lourdes. Our group of pilgrims includes those who need some assistance as well as those who want to volunteer, nurses, carers, priests and those who simply want to visit Lourdes.

The form collects some information about you and how you want to be part of Raphael Pilgrimage to Lourdes. The form also asks for some brief information about health, mobility and medications. We do ask that all those who want to travel with Raphel to provide this information. We use it to make sure we all stay safe in our time on Pilgrimage in Lourdes with Raphael.

All personal health and medical information you share is kept confidential. It is reviewed by the Chief Nurse. The information will be used to ensure appropriate support and care is available while in Lourdes. It may be used as appropriate by the nursing team if you become unwell or need medical assistance whilst in Lourdes.

If you have any concerns about supplying this information please do get in touch.
Name*

First NameLast Name
Name to be used on Raphael name badge
This is how your name will be written on your Raphael name badge
Postcode

Street Address Line 2

CityState / Province

Postcode
Date of birth*
Preferred contact phone number*
This can be your home or mobile number
Mobile Number
E-mail
example@example.com
Please indicate in what capacity you want to join the Raphael Pilgrimage - you can select more than one role.

General pilgrimAssisted pilgrimCarer for named pilgrimClergyGeneral helperNurseHealth care assistantDoctor
We are always keen for pilgrims to be able to participate in our activities and Masses. Please indicate below how you might want to get involved.

Reader at MassPlaying music at MassEucharistic MinisterReader at other Pilgrimage eventsLead the RosaryTaking the collection at Mass
There can be lots of walking during our Pilgrimage and for the processions. Sometimes pilgrims will use a wheelchair at times even if they don't need to use one at home. We are able to offer support for this if needed. We would like some information about your mobility.

The following will give us more information about your mobility.*

Rows	No	Yes	Details, please give us any further information that you want to share
Is there a limit to how much you can walk?
Do you use a walking aid e.g stick, frame?
Do you use a wheelchair at home?
Will you bring a wheelchair with you?
Do you use a scooter at home?
Will you bring a mobility scooter from home?
Do you think you might need to use a wheelchair at times during the pilgrimage?
Will you want to hire a mobility scooter in Lourdes? This will be an extra cost.
Do you need assistance getting in and out of a bath?

To help us further understand your mobility, how far can you walk without a rest?*
Thinking about your own home, what equipment or facilities will you need for your hotel room in Lourdes? Tick all that apply. You can add any further information by ticking 'other' and adding more information in the box that appears.*

NoneRaised toilet seatGrab rail beside the toiletWalk in showerShower seatCommodeElectric bedHoistOther
Which side do you need the grab rail on next to the toilet?

RIGHTLEFTEither side

Are you taking any medication including prescribed, over the counter, herbal or other?*

NoYes
Please let us know what medications you are taking. It is advised that you bring a supply of medication for 2 weeks with you. *
Have you had any operations in the last 12 months?*

NoYes
Please let us know what the operation was and when and whether there is still any medical advice that you are following. *

Do you have any dietary requirements e.g vegetarian, vegan, gluten free,low-sugar (diabetic), low salt, low fat? If yes you will be asked to give details.*

NoYes
Please give us details of your dietary requirements. Depending on your dietary requirements it can be helpful for the hotel to know what you can eat as well as what you can't eat. *
Are there any specific foods that you CANNOT eat e.g due to allergies, intolerance?*

NoYes
Please let us know what you CANNOT eat. Please let us know how severe your allergy is. *
Do you have any allergies to medications or the environment?*

NoYes
Please let us know about your medication or environmental allergies.*
If you would like to tell us anything else that you think is relevant please use the box below. If this is your first time applying to be part of Raphael Pilgrimage please let us know how you found out about us.
Thank you for taking the time to complete this form. Please now click submit. This form acts as the start of your booking. The information will be sent to the Chief Nurse who may contact you if they need any further information. This allows us to make sure we are able to support you during your time with Raphael. We will always discuss with you if we are concerned that we can't meet your needs.

Once the initial checks and registration process is complete we will send you a further email which will include a link to book your place with Tangney Tours.
Should be Empty:

Rows	NO	YES	Any relevant details of the health condition particularly if it impacts on you on a day to day basis
Asthma/COPD
Cancer
Diabetes
Epilepsy
Heart disease
High blood pressure
Kidney disease
Stroke

Rows	Yes	No
I need help with my mobility
I need help washing and/or dressing
I need help with feeding /drinking
I have continence issues
I need help during the night

Raphael Registration Form 2026

Medical information