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Festival Spirit
Making Dreams Reality
Festival experiences for life-limited and disabled people

Festival Spirit - making the festival dream a reality
Guest Application Form

Application is no guarantee of a place as selection criteria apply. Once submitted a member of Festival Spirit will contact you. If you have any difficulties completing this form we are happy to help. Please email admin @ festivalspirit.org for assistance.

MEDICAL IN CONFIDENCE

* Indicates required field

Full name *

First

Last

Date of Birth *

Email *

Postal Address *

Line 1

Line 2

City

State

Zip Code

Country

Home and Mobile number *

Please supply numbers we can contact you on during daytime and evenings, including area dialling codes

Emergency contact details. Please state name, relationship to you and telephone number *

Please supply the following: Next of kin: Name, relationship, address, contact telephone numbers. Please give details of another emergency contact: Name, relationship, contact telephone numbers

GP Name, Address and Contact Details *

Name, Address, Phone number

Your local hospital *

Please give Name, Address and Phone number

Your medical condition(s) or diagnosis *

To ensure we match the right level of care to your condition the following questions provide us with details of your medical condition.
These details are kept totally confidential by our care team and are not kept on the website.

Your mobility - Please check the boxes that apply to you *

I am able to stand with aids (please specify aids below) I am able to walk with aids (please specify aids below) I can transfer from bed to chair I am chair bound I am bed bound I have a manual wheelchair (specify below whether collapsible, leg extensions, mould etc.) I have an electric wheelchair I need hoist transferring I need a board on my bed I need a spenco for travelling

Mobility contd. For those ticked above please provide relevant details so we can provide you with the right level of care. *

Height *

Weight - kgs *

Epilepsy *

Breathing - If you have breathing difficulties, please provide us with the full details *

Dietary and feeding requirements including whether you are vegetarian etc. and any help you might need. Please bring with you any equipment you need. *

Please include details of any help you need with feeding and drinking such as special cups, straws etc. - you will need to bring these with you.

Please provide details of any known allergies or drug sensitivities (if none please state) *

Please provide details of any help you need during the night (if none please state) *

Your sight *

Your hearing *

Your speech *

Details of any speech difficulties / communication aids *

Personal hygiene - please check all that apply and provide necessary details below *

I am fully independent with personal carer I need help washing - my routine is detailed below I need help dressing - my routine is detailed below I use pads - I will bring a supply I have a catheter - I will bring a spare. Last change date is given below I self catheterise - I will bring supplies. Frequency noted below I am incontinent - details given below I use a bottle / bedpan / commode - details given below I have sore areas / wounds. Treatment details given below

Personal hygiene - please provide further details if required on any ticked items above *

Medication *

Please list all medication. You may be asked to provide a Chemist's print out. Please note whether you are self-medicating. If no medication please state 'None'

Please give any other information relevant to your care and support whilst at the Festival e.g. sleep patterns, behavioural issues *

Please provide the name(s) and contact details of the PA / carer coming with you. Please ensure they complete a PA / Carer Application form. *

Please tell us how you heard of Festival Spirit *

We would like to use pictures from our trips to enhance our website and social media pages.
Please let us know if you are willing for any images you are in to be used. Select One *

Please ensure that before pressing Submit you have answered all questions fully. By submitting this form you confirm

that all of the information given is correct and authorise Festival Spirit or its representatives to seek confirmation from your doctor if required
that you are not expecting to give birth before or within 8 weeks following the Festival
that you are not travelling against the advice of a medical practitioner
that you agree with our data privacy policies

MEDICAL IN CONFIDENCE

I agree to receiving marketing and promotional materials

Submit

Festival Spirit - making the festival dream a reality

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​Festival SpiritMaking Dreams Reality​Festival experiences for life-limited and disabled people

Festival Spirit
Making Dreams Reality
Festival experiences for life-limited and disabled people