Accessibility Companion Scheme Application Form

Please complete the following form to submit application.

Name of person*:

Address 1*

Address 2*

Address 3

City*

Postcode*

Name of person completing this application:

(incase we need to contact you regarding the application)

If you are applying on behalf of someone else please confirm you have authority to do this.

Contact number: *

Email address: *

Please note:

Melrose Club & Racing Lounge - Your application will be passed to our bookings team to contact you for processing. Access scheme discounts cannot be applied to an order that has already been placed.

Ebor/Knavesmire/Parade Ring Restaurant - Once the application is approved your discount will be confirmed to the hospitality team. Please ensure the 6 numbers of your order number following YRK is included on this application.

Enclosure*	Raceday Date*	Order Number (can be found on you email confirmation)

If the criteria is met for the application to be successful we will allocate one ticket for your Accessibility Companion on each above requested racedays. For additional racedays please complete a new application

I agree to the above details being securely held by York Racecourse until the last raceday of this application.

Yes No

If you select "No" do not continue with this application as we are not permitted to hold your documentation on file and you should therefore present it on the raceday you are attending along with photographic ID. Please note if your documents do not meet the criteria for the scheme when presented on the raceday a ticket will not be issued.

York Racecourse uses the Access Card to verify entitlement to our scheme

Please register for an Access Card at https://www.accesscard.online/apply-or-renew/

Access Card (Nimbus) with essential companion +1 Allocation

Document

Card ID No.

OR

Alternatively you can provide one of the following documents as evidence of qualifying for the scheme:

Disability Living Allowance (DLA), Attendance Allowance (AA), Personal Independence Payment (PIP), Armed Forces Independence Payment (AFIP), Scottish Adult Disability Payment.

Add document dated within the last year

Document

Document Date

If the document uploaded above is dated more than a year or doesn’t show when the award runs until please add additional page showing next review date. This includes ongoing and indefinite awards.

Document

End/Review Date

* End/review date can usually be found on one of the later pages of your award letter.

OR

Proof of Registered Blind (Certificate)

Document

** For this document type no date is required

Have you checked the document you are submitting meets the above criteria?

Yes

Any application submitted with evidence that does not show it is current by meeting this criteria cannot be processed.

Please confirm you have read the Accessibility Companion Scheme Policy

If you are unable to use the above button to submit your application form, please re-check your form and ensure all sections are completed.