Special Assistance Request Form

Booking details

Lead passenger name

Booking Reference

Name of individual requiring assistance

Contact telephone number

Email address

Medical Information & Requirements

Please specify the medical term for your condition

Are you able to walk up and down the steps to the aircraft, if required?

Yes No

Are you able to walk to your seat from the aircraft doors?

Yes No

Will you require the use of a wheelchair at the airport?

Yes No

Will you be taking your own wheelchair with you on holiday?

Yes No

How is the wheelchair powered?

Please provide the full dimensions (cm) of your wheelchair:

W
H
D

Please provide the weight (kg) of your wheelchair:

Will you be taking other medical equipment or supplies?

Yes No

Please provide details, including the type, make, model, dimensions, weight, power type (mains or battery) and if required during the flight.

Do you require pre-boarding?

Yes No

Do you require use of the Abmulift?

Yes No

Are you able to sit in standard seats with your legs bent?

Yes No

Are you able to walk on and off the transfer coach? Or do you require assistance?

Yes No, I require assistance

Will you require any medical assistance at the accommodation?

Yes No

If so, please explain in the box provided.

Any additional comments?

Please note: This information is required primarily by Blue Bay Travel. The flight operator and accommodation provider may request that further information be provided in order for any special assistance requests to be met.

Confirm & send

I confirm that the information provided above is correct.

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Blue Bay Travel is a Member of Midcounties Coop Consortium (ABTA P4796).

bluebaytravel.co.uk is a Travel Agent offering for sale holidays from various Principals and Tour Operators acting in the capacity of their Agent.

Book with Confidence. We are a Member of ABTA which means you have the benefit of ABTA’s assistance and Code of Conduct. All the packages we sell are covered by a scheme protecting your money if the supplier fails. Other services such as hotels or flights on their own may not be protected and you should ask us what protection is available. We act as The Midcounties Co-operative in connection with the sale of travel products. Unless specified as the operator, The Midcounties Co-operative is the agent of ATOL Protected Tours and other principles. All the flights and flight-inclusive packages on our websites are financially protected by the ATOL scheme. When you pay you will be supplied with an ATOL Certificate. Please ask for it and check to ensure that everything you booked (flights, hotels and other services) is listed on it. Please see our booking conditions for further information or for more information about financial protection and the ATOL Certificate go to: www.atol.org.uk/ATOLcertificate.

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Unit A4
Bellringer Road
Trentham Business Quarter
Stoke on Trent
Staffordshire
ST4 8GB

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