GREEN ISLAND HOLIDAY TRUST HOLIDAY BOOKING FORM(Please complete both parts of form) |
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All holidays start at Holton Lee, Holton Heath, Poole, BH16 6JN on a Saturday at 10.30 am All holidays finish at Holton Lee, Holton Heath, Poole, BH16 6JN on a Friday at 10.30 am Cost per person per week: £200 Anyone who brings their own accompanying helper will be charged an additional £100 (Most holidaymakers are looked after by our carers) We will ask you later for a £100 deposit if we are able to offer you a Green Island Trust Holiday.The balance is due six weeks before your holiday. There is no charge for any of the boat trips during your holiday. The trust reserves the "Right of acceptance" of holidays _______________________________________________________________________________________________________________ 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 (Please return completed form to Peter Viney 3 Gleneagles Avenue, Parkstone Poole Dorset BH19 9LJ Telephone/fax 01202 740470)
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