ES Adaptive Client Participation Form

Demographic Details

Passport Details (only needed if we are organising your holiday)

Do you hold a British passport?

Resort Details

Do they require ski/board lessons?
* Please note: If you are bringing carer/s and they would like to ski/board with you please can you ensure that they are competent red run skiers/boarders. If not, it is strongly recommended that they have lessons with European Snowsport in order to do this. Also, please be aware that if you are to be in a sit ski we will require an additional helper/carer to ski with us. We can help provide this and will contact you shortly if necessary.

Your Disability

Was your disability caused by an accident?

Adaptive Ski Lessons

Mobility Needs

Please check all that you use
 
Can you manage stairs both up and down?
Can you transfer to a chair/bed/toilet without specialist equipment?
Do you require any orthosis/prosthesis?

Care Needs

Do you have carers at home?
Do you have any episodes of urinary incontinence?
Do you have any episodes of faecal incontinence?

General Information

Health

Adaptive Equipment

If you have been skiing before?

Did you use outriggers?

Consent for Publicity and Photos

I hereby authorise and give full consent for European Snowsport Adaptive School to copyright or publish all photographs, videotapes and films in which I appear whilst participating in lessons.  I further agree that European Snowsport Adaptive school may transfer, use, or cause to be used, these photographs, videotapes or films for any exhibitions, publications, public displays, publication commercials, art and advertising purposes without limitation or reservation.

Applicant/Next of Kin

Please note, all the information given on this form will be given to the instructor and helper (if a helper is required).  This is for your safety and wellbeing.  You will be notified if a helper is required.

It is imperative that the information you have given us is correct. We reserve the right to cancel lessons if the information you have given us is misleading.

Data collection
We would like to keep you informed about fundraising events, news and developments of ES Adaptive.  Please advise us if you would prefer not to be contacted

Thank you. We look forward to skiing with you soon!