YOUR DETAILS
First Name:
*
Last Name:
*
Mobile Number:
*
Email Address:
*
Which gig would you like to attend?
*
Gig Date:
*
-
Day
-
Month
Year
Date
Ticket Reference Number
*
YOUR REQUIREMENTS
What type of space do you require within our venue?
*
Wheelchair Space
Seat
Table (Bongo's Bingo)
Essential companion ticket only
Seating available is wooden platforms on our balcony level for gigs and on a reserved table for Bongo's Bingo. We use a lift that has a capacity of 630kg that you will be able to use, which you will be escorted to by our accessibility coordinator.
Have you got a manual or electric wheelchair?
Manual Wheelchair
Electric Wheelchair
Please provide the combined weight of yourself and your wheelchair to confirm compatibility with our lift. For health and safety reasons this may be checked on arrival at the venue.
50kg-100kg
100kg-150kg
150kg-200kg
In the event of an emergency, would you be able to evacuate the venue independently, or would you require assistance (e.g., an evacuation chair)?
*
I am ambulant and can evacuate independently
I am ambulant however would need assistance from my companion to evacuate
I need the assistance of an evacuation chair to evacuate
Please note: Our venue includes multiple stairs, so thisinformation helps us ensure we have the right support in place for your safety.
Deaf and disabled customers, who would be unable to attend a gig without assistance, are entitled to a free ticket for their personal Assistant/Companion. Do you require a personal assistant/carer ticket to attend the gig?
*
Yes
No
To take advantage of this scheme, please select yes and upload on this form, copies of one of the following: Front page of PIP letter (no specific rate required), Front page of Attendance Allowance letter (no specific rate required), Photo of blue badge with name on, Evidence that registered severely sight impaired (blind) + Accessibility card.
If you answered yes to the previous question, please can you upload your document here.
Browse Files
Cancel
of
Are you attending with a paying guest?
*
Yes
No
Only one carer or accompanying guest is permitted to join you on the balcony. Any additional guests must be specified in advance and are subject to confirmation on the night.
Please upload copies of evidence:
*
Browse Files
We take the following evidence: Front page of PIP letter, Attendance Allowance letter, photo of blue badge with name on, evidence that registered severely sight impaired (blind) Accessibility card or dr's letter proof of situation (for temporary access needs)
Cancel
of
Please provide information on your access requirements in the box below, so we can make every effort to ensure your needs are met, especially in the event of an emergency.
*
If you are a blue badge holder, please enter your badge number and expiry date.
Submit
Should be Empty: