GREEN ISLAND HOLIDAY TRUST HOLIDAY BOOKING FORM(Please complete both parts of form) |
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Due to the make up of our groups we cannot always offer you the holiday date that you choose All holidays start at Holton Lee, Holton Heath, Poole. BH16 6JN on a Saturday at 10.30am and finish the following Friday at 10.30am COST £250 per week We will ask you later for a £100 deposit if we are able to offer you a Green Island Trust Holiday. The balance will be due six weeks before the holiday starts. There is no charge for any of the boats trips during the holiday. The Trust reserves the “Right of acceptance” of the holidaymakers Please complete part two below _______________________________________________________________________________________________________________ Date of birth .............................. Have you been on a Green Island Trust Holiday before? Yes No When What is your disability? .......................................................................................................... Do you need a qualified nurse to be available for your care? Yes No Do you have your own helper who wishes to accompany you? Yes No The big majority of holidaymakers are looked after by our own carers. Name and telephone number of helper :.............................................................................. Will you need any particular assistance while on holiday? Yes No Are you registered disabled? Yes No What is your weight?.............. Are you normally transferred to bed/toilet by hoist? …………… Do you use a wheelchair? Yes No Sometimes Is your wheelchair? Electric/ Manual [Please bring your own wheelchair] Can you walk? Yes No Do you use a walking aid? Yes No Can you stand? Yes No Only with support Can you use your hands fully? Yes No Can you speak? Yes No Yes fluently Do you need help with the toilet? Yes No Do you need to visit the toilet during the night? Yes No Are you incontinent? Yes No Yes doubly Do you need help with dressing? Yes No Do you need help with eating? Yes No Do you take tablets? Yes No Do you take medicines? Yes No Who will dispense your medication? Myself GI Trust Will you need a special diet on holiday? Yes No Please give details ................................................................................... Do you smoke? Yes No ( Smoking will not be available inside any of the buildings)Do you have fits? Yes No Do you need assistance during a fit? Yes No Comments.............................................................................................. Please note : Due to the nature of the accommodation, there is a high likelihood that you will be asked to share a twin bedded room RETURN TO Rob & Barbara Newman Flat 2 St Cuthburgas, 1, Cranfield Avenue, Wimborne BH21 1TH Tel: 01202 842880
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