MOMENTUM HOLIDAY HOME BOOKING REQUEST This is a booking request form to help us allocating the right cabin for your family at the best possible time period while considering other families’ needs. CONTACT INFORMATION First name: Surname: Telephone number: Our child is treated at the following hospital: Number of adults travelling: Number of children travelling: If yes, what age are the children? BOOKING REQUEST We would be interested to go for ☐ a weekend ☐ a few days ☐ a week We would love to go at the following dates (please give a number of options, if you wish, with your preferred being the first) COMMENTS /ADDITIONAL REQUIREMENTS Please add here anything else you think might be relevant for the booking process, for example if someone is using a wheelchair or how flexible you are with the dates given for a possible stay in Shorefield. Please return to Momentum by sending to: Momentum, 139 King’s Road, Kingston-upon-Thames KT2 5JE or scanning and e-mailing to: info@moment-um.org
MOMENTUM HOLIDAY HOME BOOKING REQUEST This is a booking request form to help us allocating the right cabin for your family at the best possible time period while considering other families’ needs. CONTACT INFORMATION First name: Surname: Telephone number: Our child is treated at the following hospital: Number of adults travelling: Number of children travelling: If yes, what age are the children? BOOKING REQUEST We would be interested to go for ☐ a weekend ☐ a few days ☐ a week We would love to go at the following dates (please give a number of options, if you wish, with your preferred being the first) COMMENTS /ADDITIONAL REQUIREMENTS Please add here anything else you think might be relevant for the booking process, for example if someone is using a wheelchair or how flexible you are with the dates given for a possible stay in Shorefield. Please return to Momentum by sending to: Momentum, 139 King’s Road, Kingston-upon-Thames KT2 5JE or scanning and e-mailing to: info@moment-um.org
shorefield-booking-request-form.docx