Essential Companion Scheme Registration Form

Title *

First Name *

Last Name *

Address *

Post Code *

Phone Number *

Email

Are you under 18? *

Date of Birth (DD/MM/YY)

Are you a visitor to the Isle of Man? *

Disability Type *

Ambulant disabled (non-wheelchair user)
Visual impairment or blind
Learning disabilities
Wheelchair user (electric)
Wheelchair user (manual)
Wheelchair user (prefer venue seat)

Are you registered disabled? *

Registration number (if applicable)

Accept Terms & Conditions *

I confirm in order to access performances at VillaGaiety, I require the presence of an assistant, and accept terms & conditions laid out for the Essential Companions Scheme.

Consent to store data *

Yes - I consent to my data being processed and stored
No - I do not consent (this form will not be submitted)

Essential Companion Scheme Registration Form

Essential Companion Scheme

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