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Fishguard and Goodwick Jemima Rowing Club
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First applicant details (use just this name for setting up GoCardless payment in step 2)
E-mail
Emergency contact details
Please indicate if any of these apply to you
(optional)
Manual wheelchair user – self propelled
Manual wheelchair user – assisted
Electric wheelchair user
Learning disability – moderate
Learning disability – severe
Visual impairment
Hearing impairment
Amputee
Other physical difficulty
Speech and language / communication difficulty
Please give details of any modifications needed to enable you to access the sport
(optional)
I have read the 'Boat preparation and safety' document and take responsibility for my own health and safety
Second applicant details
E-mail
Emergency contact details
Please indicate if any of these apply to you
(optional)
Manual wheelchair user – self propelled
Manual wheelchair user – assisted
Electric wheelchair user
Learning disability – moderate
Learning disability – severe
Visual impairment
Hearing impairment
Amputee
Other physical difficulty
Speech and language / communication difficulty
Please give details of any modifications needed to enable you to access the sport
(optional)
I have read the 'Boat preparation and safety' document and take responsibility for my own health and safety
