ONE Event 2021 Special Needs Request Form

ONE Event 2021 Special Needs Request Form

Complete this form if you have a Special Need and/or disability and require our support. All forms must be submitted by 31st July 2021 for consideration.
General Details

Please complete this section with the details of the person with Special Needs and/or Disabilities
Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Age at Event (August 2020)*
Venue Attending
Please tell us which venue you plan on attending for main meetings
Church Attended*
Just in case we nee to verify any details with your Church Leader
Church Leader*
Booking Contact

Please complete this section with details of the booking contact
Full Name (If different from above)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
E-mail*
Mobile Number*

Area CodePhone Number
Phone Number

Area CodePhone Number
Are you camping, Event pass, Residential or Day Visitor*

CamperEventResidentialDay Visitor
Carer Details

Does the person with special needs and/or disabilities have a carer? if so please tell us below, please note we can only supply free carer passes to carers who are only attending the event to care.
Carers Name

First NameLast Name
Carers Mobile Number

Area CodePhone Number
Please confirm if you carer is only attending the event due to your special needs?

Yes, they are only attending because of my needsNo, they are attending for their own benefit as well

Residential Accommodation

Our Residential accommodation is based at Bishop Grosseteste university, around a 5-10 minute drive from the Lincolnshire Showground. All rooms have double beds and lift access. They are suitable for those with minor physical disabilities. For those who require further provision the university are able to offer disable wet rooms and ground floor accommodation. Please specify this below.
Do you require a disabled wet room?*

YesNo
Do you require a ground floor room?*

YesNo

Special Provision

The ONE Event is committed to facilitating individual special needs and requirements, please list below under the relevant headings any special provision you require during the event.
Physical & Mobility Needs

Please tell us about any physical or mobility needs you/ your child might have
Physical/ Mobility Needs
Will you be using a mobility aid, wheenchair or any other Special Equipment?*

YesNo
Do you require a ONE Event disabled parking pass?*

YesNo
Please upload a picture of your current valid Disabled Parking Permit

Browse Files

Cancelof
Will you be bringing a guide, assistance or therapy dog with you?*

YesNo

Guide, Assistance or Therapy Dogs

Please tell us if you will be bringing a guide, assistance or therapy dog with you to the event.
Guide and Assistance Dogs should be accredited and trained by a relevant organisation. Therapy Dogs must comply to the following criteria
1. Both the dog and handler should of received accredited training
2. You should hold relevant public liability insurance for the dog
3. The dog must be identifiable by a vest which clearly states 'Therapy Dog'
You will be asked to supply evidence that all this criteria has been met before we can authorise your dog onto site.

Please note that except for Guide, Assistance and Authorised Therapy Dog's we do not allow any other Dog's onto site.
Please Specify*

Guide DogAssistance DogTherapy Dog
Dog Breed*
For Guide and Assistance dogs please state which organisation your dog is accredited with
For Therapy Dog's please confirm you have the relevant provisions in place

Dog handler trainingDog trainingPublic Liability InsuranceIdentification vest
Once you have completed this form please email certificates to admin@groundlevel.org.uk who will then be able to confirm if your dog can be authorised to attend.

Special Provision - Electric Hook Up
ONE Event is based on a agricultural showground and is unable to provide commercial campsite facilites. Electric hook-up provision can only be provided for those with a genuine medical requirement.
Do you require an electric Hook-Up?*

YesNo

Electric Hook-Up Provision
All electric hook-ups are subject to acceptance.

We have a restricted number of facilities for hook-ups and therefore while we try our best to meet your requirements we may not be able to grant or approve every request. Confirmation will be sent to you in August regarding if your hook-up has been granted or not.
Please state the reason why you qualify for an Electric Hook-Up

Sensory, Communication & Interaction Needs

Please tell us about any hearing, speech, communication or visual difficulties you/your child may have.
Sensory, Communication & Interaction Needs
Do you require Sign Language?*

Yes - BSLYes - MakatonNo
Do you require Large Print Lyrics?*

YesNo
Do you require a Hearing Loop?*

YesNo

Cognition & Learning

Please tell us if you/your child have difficulties with reading and/or writing; How can you be helped with these? (I.e. Simplified information, One-to-one support e.t.c.)
Cognition & Learning

Behaviour, Social and Emotional Development

If you/your child has behavioural difficulties it is essential that we are aware of them. Please state any relevant conditions below
Behaviour, Social & Emotional

Confirmation
I hereby give permission for First Aid by the venue qualified First Aider to be administered if it is felt that it would jeopardise the safety of myself/my child/young person to wait for on-site paramedics to arrive.*

Yes
Are there any other ways in which you require special provision or facilities that are not already outlined as provided within the "Special Needs Information" or that you have not already outlined on this form?
I confirm that all of the above information stated is true to the best of my knowledge.*

Yes
Form Completed By*
Relationship to person with Special Needs and/or Disabilities*

I am the PersonSpouse/ PartnerParent/ GuardianCarerOther
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Residential Accommodation