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The Gables

Multi Activity Holiday Centre

Booking Form

Date Of Visit        From:_______________      To:_______________     Days Total:________

Transport Required: Yes/No

Departure Address:  
 
 
 
 
Telephone:

One To One Care Required:      Yes/No     (See Terms & Conditions)

Guest Name Client Profile Ground Floor Total Cost
       
       
       
       
Correspondence and Billing address:
 
Contact Name: Telephone:
Contact Address:
 

Medication Chart Required Client Profile Enclosed Mileage Supplement Deposit Enclosed
       

I confirm I have read and accepted the terms and conditions of the Gables and have disclosed all relevant information on the client profile forms.

In the event of a cancellation I shall be responsible for all cancellation charges as set out in the terms and conditions

Signed:_______________________      Name:_______________________      Date:___________

Please make cheques payable to Choice Care Services