Olympic Holidays - Special Assistance Form
1. Assistance Details
2. Contact Details
3. Review
4. Thankyou
Assistance Details
Customer Details
Booking reference
*
Lead passenger
Passenger(s) requiring assistance
*
Airline
Departure date
*
Type of disability
*
Which service is required
*
WCHR - Check in to boarding gate
WCHS - Check in to boarding gate & ambulift onto plane
WCHC - Check in to boarding gate, lifts & totally immobile
Wheelchair & Scooter Details
Wheelchair required
*
Yes
No
Taking own wheelchair
*
Yes
No
if no, please state "N/A" to dimensions below
Model of wheelchair
Taking own scooter
Yes
No
if no, please state "N/A" to dimensions below
Model of scooter
Manually operated
Yes
No
Battery operated
Yes
No
Type of battery
Dry cell
Wet cell
Gel cell
Collapsible
Yes
No
Weight
*
(Please state unit of measurement)
Open width
*
(Please state unit of measurement)
Open height
*
(Please state unit of measurement)
Open depth
*
(Please state unit of measurement)
Closed width
*
(Please state unit of measurement)
Closed height
*
(Please state unit of measurement)
Closed depth
*
(Please state unit of measurement)
Other apparatus being taken
(i.e. Crutches, Walker etc)
On Board Assistance
Can passenger(s) walk unaided
Yes
No
Can passenger(s) bend knees & sit in a standard seat
Yes
No
Does the passenger(s) suffer from asthma/breathing difficulties
Yes
No
Is the passenger(s) taking any medication with them on board, if so please state what
Will the medication be needed during the flight
Yes
No
If travelling alone is the passenger able to look after their own on board needs
Yes
No
Any other assistance required whilst on board the flight
Transfer Details / Accommodation
If transfers have been booked with us, are the passenger(s) able to climb the coach steps?
If NO, please provide details
*
Is the accommodation suitable for the passenger(s) who require assistance? *Please note, it is your responsibility to make sure the accommodation booked is suitable for your needs. Room requests are not guaranteed.
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