Please
fill in the following form, print it out and send to:
Dorset Association for the Disabled
Weymouth Outdoor Education Centre
Knightsdale Rd
Weymouth
Dorset
DT4 0HS
(Tel/Fax: 01305 761840)
| Branch: | |
| Name: | |
| Address: | |
| Tel number | |
| Name of GP: | |
| Address: | |
| Disability: | |
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Are you registered with Social Services: |
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| Do you use: | |
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Wheelchair
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Walking
frame/sticks
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Car
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Public
transport
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| Assistance required: | |
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Transport
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Shopping
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Visiting
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Holidays
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| Hobbies and interests: | |
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Other useful information: |
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