Step 1 of 6 16% How long would you like to stay?1 Week2 Weeks3 WeeksDate From(Required)Bookings are from 4pm Thursday to 10am the following Thursday. Currently available start dates are highlighted. DD slash MM slash YYYY Family name or name of organisation:(Required) Name of the point of contact for this booking:(Required) Billing DetailsName(Required) First Last Address(Required) Street Address Address Line 2 City County Post Code MobileLandlineEmail(Required) Different Lead PersonIf the Lead person differs to the person named above, please include their details hereLead Name First Last Lead Address Address line 1 Address line 2 Town / City County Post Code Lead PhoneLead Email Party MembersPlease include the full name of all other members of your party (if known)How Many(Required)Please enter a number from 1 to 6.How many people will be staying at Berwick Cottage? (max 6)Party Members(Required)Would you like a Motor Cruiser Trip at our centre in Neatishead? Yes (This is included with your booking on a Monday afternoon only). How many people in the group have a disability(Required)Please enter a number from 1 to 6.Please indicate below the nature of the disability along with any additional information that you feel you need to share with us.RequirementsIf you require any of the following, please tick (check) each item listed below. Please note there is no additional charge.Requirements 2x Waterproof Pillows 2x Waterproof Duvets Shower wheelchair/commode (tilt-in-space) Height adjustable perching stool Stainless drip stand Urine bag stand/holder Zimmer frame with wheels Manual wheelchair (standard adult size) Child's highchair (able bodied) Manual hoist (slings not provided) Baby intercom Will anyone in your group: be using sharps, swabs or dressings? have a guide/hearing dog? be bringing or using specialist equipment not supplied by us? Details for any specialist equipment: Deposit PaymentDeposit Price: Credit Card Cardholder Name Card Number Expires CVV / CVC Postal Code
