Booking for Adults with Intellectual Disability Question Title * 1. What is your first name? OK Question Title * 2. What is your last name? OK Question Title * 3. At what email address would you like to be contacted? OK Question Title * 4. Date of Birth: Date / Time Date OK Question Title * 5. What is your gender? Female Male OK Question Title * 6. We'd like to know if you've had a holiday away from your family before. By this we mean, have you been on respite or recreational camps where no member of your family went with you? Yes No OK Question Title * 7. We need to understand if you are able to take basic care of yourself, or if you need help. For example, can you dress yourself? Can you use a shower by yourself, or with just a little help (like turning on the taps)? And can you use toilet's including public toilets safely yourself? If you need extra help that's ok, we just need to understand how much help so we can make sure we have the right number of disability support workers.In general do you think you are able to handle dressing yourself, and attending to your personal care either by yourself, or with just a little help? Yes No If you answered No, please explain how you would need help. OK Question Title * 8. We need to understand how your disability affects your ability to get along with others. When you go on holiday or a tour, you will be meeting new people, and we need to make sure that everyone in the group is going to be safe with each other. We also need to know if your behaviour might cause damage to any of the places we visit, or places we stay at.It's ok if you sometimes get anxious or sad, and need some quiet time. But it is not ok to hurt other people, get in fights, steal things or damage property.We need to understand if you have ever had a problem with your behaviour in the past? No, I've never had a problem with my behaviour. Yes, but it was a long time ago and I have strategies to handle difficult situations. Yes, and I will need additional support to manage my behaviour. Please tell us anything else we need to understand. OK Question Title * 9. Everyone has a different level of independence. We'd like to know what things you might need extra help with on this tour/holiday. Please tick any tasks/skills you need extra help with ... Reading Using money Telling the time Looking after my personal belongings Communicating with other people (non verbal/limited verbal skills) Hearing (I'm hearing impaired) Vision (I'm vision impaired) Mobility (I have mobility impairment) Feeding Medications Conflict resolution Remembering things Energy (I get tired easily) Bedwetting Travel sickness Wandering off Too much energy Cooperating with others OK Question Title * 10. Our ratio of passengers to carers is generally 1:3. Our carers stay with the tour, but are not on duty during the night. We need to understand if you need more assistance than this. Please tell us about what you need. OK DONE