Check if a beach wheelchair is available

Before completing the form

Review how to use the beach wheelchair

Make sure you know about beach accessibility at the following pages:

Half Moon Bay beach (currently unavailable)
Hampton Beach

Which beach do you want to go to? *

Hampton Beach

What day would you prefer? *

Day

Month

Year

Please choose a Saturday or Sunday.

What time/s would you like? *

Midday to 1:30pm

1:30pm to 3:00pm

3:00pm to 4:30pm

Wheelchair users details

First name *

Last name

Support person details

First name *

Last name

Email *

We will confirm via this email.

Phone *

We will use this as primary contact number.

1 (Hidden)

Disclaimer *

I acknowledge that I have read and understood the safety information and will abide by all requirements. I hereby agree to indemnify Bayside City Council, Push Mobility, and the relevant site life saving club against all claims directly or indirectly arising from or incurred in connection with, damage to or loss of property, or injury, arising from the use of the beach wheelchair and matting whilst in my care. I confirm that the information supplied above is true and correct and I agree to this loan agreement.

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Check if a beach wheelchair is available

Before completing the form

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