VIP Application Form

Festival Spirit - making the festival dream a reality

Please note you must be 18 or over to apply. 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 call David Tinker on 078 0119 2590 for assistance.

MEDICAL IN CONFIDENCE

Full names *

First

Last

Which festival(s) are you interested in attending? *

Date of Birth *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone numbers *

Emergency contact details *

About your GP *

Your local hospital *

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.

Mobility contd. For those ticked above please provide relevant details so we can provide you with the right level of care. If you need us to provide an electric wheelchair please state whether right or left handed *

Height *

Weight - kgs *

Diabetes *

Epilepsy *

Do you have a pacemaker? *

Breathing (please check all boxes that apply) *

No breathing difficulties I use an inhaler and will bring it with me I use a nebuliser and will bring it with me I use oxygen and will bring a supply I use a ventilator and will bring with me Other breathing issues - details below

Details of breathing difficulties *

Dietary and feeding requirements (if any) including help you might need and equipment (please bring with you) *

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

Please provide details of any known allergies or drug sensitivities (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 - details of ticked items above *

Medication *

Please give any other information relevant to your care and support whilst at the Festival *

Please tell us how you heard of Festival Spirit *

We would like to use pictures from our trips to enhance our website and Facebook 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

MEDICAL IN CONFIDENCE

Submit

Festival Spirit - making the festival dream a reality