Carer Acknowledgement – Wheelchair Participation

For carers attending with a wheelchair user where the carer will skate whilst pushing the wheelchair. Please complete in addition to the standard Adult or Child waiver.

Only complete this form if you are the carer skating whilst pushing a wheelchair.

Everyone attending must also complete the standard waiver (Adult or Child).

I confirm that I am the carer for the wheelchair user attending the roller disco and that I will be skating whilst pushing the wheelchair.
I confirm that I am confident and competent on roller skates and able to safely control, steer and stop the wheelchair at all times.
I understand that a ticket must be purchased for BOTH the Wheelchair User & the Carer
I understand that skating whilst pushing a wheelchair carries additional risks to myself, the wheelchair user and other participants.
I agree to:
• Skate at a controlled speed appropriate to the session
• Remain towards the outer edge of the skating area
• Follow all instructions given by the event organisers
• Wear a high-visibility vest while skating and pushing the wheelchair if/when requested by the organiser, for visibility and safety (provided on the day)
I understand that the organiser reserves the right to restrict or stop participation at any time if skating is deemed unsafe.
I acknowledge that I take responsibility for my actions and for the safe control of the wheelchair whilst skating.

I understand that waivers must be completed for BOTH the Wheelchair User & the Carer
I understand that roller disco sessions include loud music and disco-style lighting, including flashing lights.
If the wheelchair user is unable to sign for themselves, the carer may sign on their behalf.
I confirm that the carer who will be skating whilst pushing the wheelchair is 18 years of age or over.
I confirm that the wheelchair being used is a non-motorised (manual) wheelchair.