Participant Application

(Page 1 of 4) This application should take between 10-15 min.

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Program Eligibility

The Caddie Companion Initiative is designed to help individuals experiencing dementia-related symptoms remain active, connected, and engaged through the game of golf while providing meaningful respite for care partners.

To participate in the program, individuals should meet the following eligibility criteria:

• Be age 50 or older (exceptions may be considered on a case-by-case basis)

• Have a diagnosis of Alzheimer’s disease, another form of dementia, mild cognitive impairment (MCI), or exhibit early dementia-related symptoms impairing your ability to golf.

• Have a current or past interest in golf and a desire to participate in golf-related activities. Participant must have their own equipment including regulation clubs, golf balls, golf shoes and any other item required for the sport.

• Be able to engage safely in a golf-related activity with volunteer support which includes but is not limited to walking short distances, holding and swinging a golf club, standing for periods of time, light physical activity, and social interaction with volunteers and other participants

• Have a care partner, family member, or responsible party available to complete intake forms, provide emergency contact information, and assist with communication as needed

Physical Requirements

Please confirm the participant can:

• Ride safely in a golf cart and/or walk short distances with or without assistance

• Tolerate outdoor activity for approximately 1–3 hours

• Participate in light physical activity such as swinging a golf club, putting, or visiting a driving range

• Bring our own clubs, appropriate footwear and other golf related equipment

Safety Considerations

Participants may not be eligible if they:

• Present a significant risk of harm to themselves or others

• Require skilled medical supervision during program activities

• Require administration of medication while on the golf course

• Have medical or behavioral conditions that cannot be safely accommodated within available staffing and volunteer resources

• Have a recent history of wandering or aggression that cannot be safely managed during outdoor activities

• Cannot perform all of their daily acts of living.

Program Review

• All participant applications will be reviewed individually. Eligibility decisions are based on the participant’s ability to safely participate and benefit from the program, with reasonable accommodations considered whenever possible.

• The Caddie Companion Initiative reserves the right to request additional information from care partners or healthcare providers when necessary to determine appropriate participation.

• Our goal is not to exclude individuals, but to ensure a safe, enjoyable, and meaningful experience for every participant, volunteer, and caregiver. We do not discriminate against anyone based on race, color, religion, sex, age, or disability.

• If accepted into the program, a participant will be periodically evaluated for continued eligibility. If Caddie Companions Initiatve determines a participant is no longer eligible for any reasons, a representative will discuss this decision with the participant and care partner.

Participation Requirements

For the safety of the participant, care partner and our volunteers, participants will be eligible for our program once:

• We receive this fully completed Participant Form

• We receive signed copies of the Emergency Medical Authorization, Media Release and Participant Release and Waiver of Liability

• We complete a screening phone call with the care partner

• We receive a physician participation statement (if requested)