HOLY ROOD HOUSE
CENTRE FOR HEALTH
AND PASTORAL CARE
BOOKING FORM for INDIVIDUALS
PLEASE RING BEFORE
POSTING THIS FORM TO CONFIRM AVAILABILITY
| Mr/Mrs/Miss/Ms/Other________
Name(s) _______________________________________
Address _______________________________________
_______________________________________________
_______________________________________________
Postcode ________________
Tel No: _______________
|
Date of visit______________________
Time of arrival ____________________
Departure date ___________________
Please meet train at ______________
Time
Please meet bus at
______________
Time |
Please tick or give appropriate
answers to the following:
a. Visiting for:
quiet rest [ ] study period [ ] counselling [ ] body therapies
[ ]
We ask for a donation for therapies to
support the work of the House:- £20/40 waged, £15/20 unwaged
Other reasons (please state)
____________________________________________________________
b. Diet: please
state any special needs: __________________________________________________
c. Need chair
lift: [ ] orthopaedic bed: [ ]
d. If for two
people do you require: separate rooms: [ ]
double bed: [ ] twin beds:
[ ]
Emergency Name and Contact No. ______________________________________________ Further information to help
us make your stay happy and
comfortable: __________________________________________________________________________
Please return this form
together with a non-refundable deposit of £25 per person to:
Holy Rood House,
10 Sowerby Road, Thirsk,
North Yorkshire, YO7 1HX
Please
make cheques payable to ‘Holy Rood House’.
If
you need an acknowledgement, please enclose a stamped addressed envelope.
If
you are a taxpayer please complete the Gift Aid form below
Signed ______________________
Date ______________
For office use only:
Deposit Paid £____ Diary [ ] M/L [
] Card [ ]
|