Beach Walker Hire Form

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Application for free hire of Beach Walker

All fields are required except where indicated
 

Name of Hirer


Support Persons details

Does 'the user' require a support person to operate the beach walker:
Please note: If ‘the user’ is not confident and is at risk of falling whilst using the equipment, a support person will be required to assist whilst using the beach walker.

Name of User

 

Available during office hours Monday - Friday, 8.30 am to 16.30. Sat and Sunday 10.00 am to 14.00hrs

Time hire beginning at (2 hours blocks):
Declaration:
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Contact

Address

9 Coleville Crescent,
Spearwood 6163

PO Box 1215, Bibra Lake DC,
Western Australia, 6965

Language Support

Cockburn Nyungar moort Beeliar boodja-k kaadadjiny. Koora, yeyi, benang baalap nidja boodja-k kaaradjiny.
Ngalak kaadatj dayin boodja, kep wer malayin. Ngalak kaadatj koora koora wer yeyi ngalang birdiya.

City of Cockburn acknowledges the Nyungar people of Beeliar boodja. Long ago, now and in the future they care for country.
We acknowledge a continuing connection to land, waters and culture and pay our respects to the Elders, past, present and emerging.