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 / Butlins T&C: Click here

Holiday Confirmation Form

Please complete all relevant questions on this form

HCF

Grant Reference (this will be in the email we sent you and starts with KFG)

Are you aware the break will be provided at the earliest opportunity? -this could be as soon as in two weeks time.

Yes that is fine

No, please cancel my application

Are you aware you will need to pay a £75 refundable security deposit and a £75 cleaning and linen hire fee?

Yes that is fine

No, please cancel my application

Title

First Name

Surname

Mobile Phone

Address

Address Line 1

Address Line 2

City

County

Postcode

Do you need a wheelchair accessible unit?

Yes, I need wheelchair access and a wet room

No - any holiday home is fine

We need to know if you need an accessible (wheelchair friendly) caravan. Unless you specifically need a wheelchair accessible unit you may be booked into either holiday home.

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.

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

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

Your break will most likely be
MID WEEK MARCH 2024

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 checking-in/out 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 first and last name of each guest below, including their title prefix.

LEAD GUEST (YOU)

Title

‎

First & Last Name

‎

DOB (DD/MM/YY)

‎ ‎

Age

Second Guest

Title

‎

First & Last Name

‎

DOB (DD/MM/YY)

‎

Age

Third Guest

Title

‎

First & Last Name

‎

DOB (DD/MM/YY)

‎

Age

Fourth Guest

Title

‎

First & Last Name

‎

DOB (DD/MM/YY)

‎

Age

Fifth Guest

Title

‎

First & Last Name

‎

DOB (DD/MM/YY)

‎

Age

Sixth Guest

Title

‎

First & Last Name

‎

DOB (DD/MM/YY)

‎

Age

Seventh Guest

Title

‎

First & Last Name

‎

DOB (DD/MM/YY)

‎

Age

Eighth Guest

Title

‎

First & Last Name

‎

DOB (DD/MM/YY)

‎

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 Cleaning & Linen Charge 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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Respite Breaks

Holiday Confirmation Form

Horley Green Works
Horley Green Road
Halifax HX3 6AS

Registered Charity Number 1146884 & Limited by Guarantee Number 10650385

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