Essential Companion Organisation Application

Organisation Name

Contact Name

Are you a
CharityLocal/Heath AuthorityPrivate Company

Carer Requirements
1:11:21:4Other

Other (please specify)

First line of organisation address

Postcode

Email

Telephone

Which of the following preferences would you like us to assist you with in future bookings?

Aisle Seat
Wheelchair Space
Large Wheelchair Space
Stalls Seat
Induction Loop

Please provide as much information as possible as to why members of your group require an Essential Companion:

Please tick to confirm you have read the terms and conditions of becoming an Essential Companion (required)