Gifted breaks - Together for Short Lives

Lead booker

The lead booker will be the main contact for Together for Short Lives and Center Parcs, and should be one of the guests on the break.

Name(Required)

First name Surname

Date of birth(Required)

Gender(Required)

Please tell us your gender(Required)

Address(Required)

Street Address Address Line 2 City/town/village Postcode

Region(Required)

Phone number(Required)

Email(Required)

Enter email address Confirm email address

Referral information

Who referred you for this break?(Required)

Together for Short Lives

A hospice

Which hospice referred you?(Required)

Guest information

Total number of guests(Required)

Accommodation is in a three-bedroom Woodland Lodge for up to 6 people (plus 1 child under 2-years-old).

Please enter a number from 2 to 7.

Click the symbols to add more adults or children to the booking.

Adults(Required)

First name

Surname

Date of birth

Relationship to lead booker

Children(Required)

First name

Surname

Date of birth

Relationship to lead booker

Holiday details

Your three preferred holiday dates(Required)

Stays can be at weekends (Friday to Monday) or midweek (Monday to Friday). Excludes school and public holidays.

Start date

End date

Preferred Center Parcs Village(Required)

Please tell us why this break would benefit your family(Required)

Accessibility

Adapted lodges are designed for guests with disabilities and wheelchair users. Features include:

Open plan living and dining area
Fully equipped kitchen with lower worktops
Dedicated parking with ramp access
Spacious adapted bedrooms with an electric bed
Walk-in/wheel-in shower (no hoists provided in accommodation)

Hoists are available in Center Parcs swimming pool areas. If you have specific access needs, we can discuss these once your booking is confirmed.

Do you need an adapted lodge?(Required)

No

Yes

Do you have any specific access needs?(Required)

No

Yes

Access needs(Required)

Travel arrangements

Do you have access to transport?(Required)

No

Yes

Car registration(Required)

Lead driver(Required)

First Last

Your data

The details you submit in this application will be used to assess your eligibility and arrange your holiday, as well as for safeguarding and reporting purposes. Relevant details will be shared with Center Parcs in order to arrange your break.

By submitting this form, you consent to our processing your data in line with our privacy notice. You can withdraw or update your consent at any time by calling 0117 989 7820, or emailing supportercare@togetherforshortlives.org.uk

Gifted break booking form