Respite Breaks

Holiday Confirmation Form

Congratulations! Your support application for a respite break has been accepted and we now need to collect some information on your family so we can book the break for you.

Please remember this break is provided on a self-catering basis in one of our caravans and we do not include any entertainment passes in our respite breaks, but are pleased to provide a list of great locations to visit with your family on our main respite break page.

Application T&C: Click here / Booking T&C: Click here / Butlins T&C: Click here

Holiday Confirmation Form

Please complete all relevant questions on this form

HCF

Grant Ref (this will be in the email we sent you)

Title

First Name

Surname

Mobile Phone

Address

Address Line 1

Address Line 2

City

County

Postcode

Please select your preferred holiday home.
We need to know if you need an accessible (wheelchair friendly) caravan.

Sandhills 246
Our accessible caravan has wheelchair ramped access, wide doors and a full wet room. The master bedroom boasts a kingsize bed with Otty mattress and basic hoist. The twin bedroom has two full size single beds and a small double pull-out is in the lounge area. Maximum of 6 guests.

Sandhills 261
Our second caravan is three bedrooms and include a bedroom with a double bed, two twin rooms and a small double pull-out in the lounge. Maximum of 8 guests. Please be aware, this caravan is not suitable for wheelchair users, or those with additional mobility needs.

Selection

SANDHILLS 246 - 6 Berth (Wheelchair friendly)

SANDHILLS 261 - 8 Berth (Not Wheelchair accessible)

NO PREFERENCE - Any available unit

Booking Dates
Our respite breaks are to be provided at the earliest opportunity to help aid positive mental health of your entire family. You do have the option of selecting a Mid-Week or Long-Weekend break, but this will be subject to availability.

Mid-Week Breaks are Monday to Friday
Weekend Breaks are Friday to Monday

Your break will most likely be:
midweek March break

Subject to our latest availability. You may be offered an earlier date if we have cancellations or a later date if we have limited availability.

Break Preference (not guaranteed)

Guest Details
As per the Butlins terms and conditions, we need to take the full names and dates of births of all guests to provide your holiday. Butlins handle the check-in of our guests.

Important: Please remember we can only provide this free respite break to your immediate family who reside in your household. Adding friends or extended family members may lead to the offer of a break being withdrawn.

Please enter the full name of each guest below.

LEAD GUEST
(grant applicant)

Guest Name

Guest DOB

Age

2ND GUEST

Guest Name

Guest DOB

Age

3RD GUEST

Guest Name

Guest DOB

Age

4TH GUEST

Guest Name

Guest DOB

Age

5TH GUEST

Guest Name

Guest DOB

Age

6TH GUEST

Guest Name

Guest DOB

Age

7TH GUEST

Guest Name

Guest DOB

Age

8TH GUEST

Guest Name

Guest DOB

Age

I understand my information that I have provided will be stored on a secure password protected system for a period of time as defined by law. The information will be used for the processing of my respite break which will include sharing information with Butlins and a central owners database.

I understand that the respite break is provided on a self-catering basis with no Butlins entertainment passes included in the break. No member of my holiday party will harass any members of the Butlins team to try and gain entry to the main holiday park.

I understand that if I wish to make any amendments or changes to the respite break it will be subject to a £25 amendment fee, failure to pay this charge will may result in cancellation of the respite break. Amendments include the names or number of people attending the respite break or the amendment of the actual respite break dates.

I understand the break will be offered at the first available date and understand the charity cannot accommodate specific date requests. I agree to the Support Terms and Conditions and the Butlins Terms and Conditions and the break is subject to the £75 Security Bond and the £75 Service Charge (covers bed linen, cleaning, gas and electricity for your stay) being paid within 7 days of the invoice being received.

Signature

Please use your finger or mouse to sign this document.

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