Special Request Checklist

Holiday/travel booking reference

Your arrival date

Ship/flight name and details

Your departure date

How would you describe your disability?

Can you walk or travel on your own in an unfamiliar place without assistance?
YesNo

Do you use a wheelchair when travelling?
YesNo

Can you walk up and down steps or a gangway to board the plane or ship without assistance?
YesNo

If a transfer coach is provided from the airport to the hotel or for any excursions as part of your travel arrangements, Can you board and leave a standard coach without additional assistance other than from any companion you may be traveling with?
YesNo

Would it be difficult for you to see, hear or understand important information – for example
, departure information or information about what to do in an emergency?
YesNo

Can you do the following without assistance ?
Breath without supplementary oxygen
YesNo

Feed yourself
YesNo

Administer your own medication
YesNo

Use the toilet facilities
YesNo

Lift yourself in and out of your seat
YesNo

Find exits in a case of an emergency
YesNo

Are you asthmatic or do you have other breathing difficulties?
YesNo

Are you traveling with an assistance dog?
YesNo

Can you walk up and down stairs unaided?
YesYes - some of the timeNo

Would you prefer a room on a particular floor ?
YesNo

Would you prefer a room near the lift?
YesNo

What special facilities do you require in your room?
grab railsaccessible telephonevibrating pads for alarm/alarm clockfridge for medicationTV with Teletextlevel entry showeradjustable bed heightwashbasin with lever tapsOther

Do you have a special dietary requirement for medical reasons?
YesNo

PLEASE indicate the reason for request

Sign In