Personal Information of main contact

Preferred Title

Your name*

Telephone Number*

Your email*

Address (including postcode)*

Number of vehicles and Registration Plates:

Full Names of all Guests and ages of children:*

A little about why you are applying

Why do you want to go on this holiday? Please describe any specific caring needs or family circumstances that warrants this break.:*

What benefit do you feel that you will get from this holiday?*

When was your last holiday and what difficulties did you face, if any?*

Any other requirements?

Would the disabled child benefit physically from quiet surroundings?
High Chair
Travel Cot
Wheelchair Access
Profiling Bed and Hoist
Little Hiccups’ Delta Buggy (available to hire £4 a day)
Little Hiccups’ Travel Pod (available to hire £4 a day)

Other Requirements not mentioned above:

Your Availability

You can find information about the venues, lodges and dates for the holidays on the website at https://www.littlehiccups.co.uk/the-principle-trust-holidays. Please use that information to answer below.

Please note, there is more availability for holidays out of term time. Please let us know below whether or not you are able to use a term time slot below.

List your preferences in order from 1-3 (1 being the best option for you). If you cannot make a particular option, write a ‘x’.

Please note: if you have no particular preference between one or more options, you can use the same number more than once.

Whitecross Bay - 21st May 2022 - 28th May 2022

Whitecross Bay - 23rd July 2022 - 30th July 2022

Whitecross Bay - 10th Sept 2022- 17th Sept 2022

Do you have a preference for dates? And why?*

Thank you for completing the form. Good luck!

Declaration

By submitting this form, I declare that the information given in this form is true, complete and accurate. I have read and agree to accept the terms and condition of booking. I am over 18 years of age and agree to be wholly responsible for the balance of the deposit be paid four weeks before occupancy. I agree to leave the cabin in a clean and tidy condition and be responsible for any damages and breakages caused over the hire period.