MOMENTUM RESPITE BREAK – CABIN BOOKING FORM

Please note our availability calendar is subject to change. Priority for bookings is given to families who are currently undergoing treatment and who have not stayed in the cabins before. Additionally, during peak periods priority is given to families with school age children who are currently undergoing treatment and who have not had a respite break with us before.

Please complete all the requested forms in order for us to process your booking request.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City County Postcode

Phone number(Required)

Email(Required)

Hospital your child is being treated at (if relevant)

Family Support Worker(Required)

Booking Information

Our cabins can be used for week bookings, Monday – Friday, or weekend bookings Friday – Monday with 4pm check in and 10am check out. For off-peak bookings (outside of school holidays and weekends) other timings may be possible, by prior arrangement.

Families are very welcome to enjoy the cabins on more than one occasion; however, we do suggest a voluntary donation of £120 for any subsequent breaks. This helps us to cover the rising costs of cleaning, maintenance and utility bills so that we can continue to offer this valuable service to all our supported families when they most need it.

Please provide us with your provisional booking dates – as discussed with the respite coordinator

Preferred date 1 – start(Required)

Preferred date 1 – end(Required)

If your child is currently in active treatment or receiving oxygen; by returning this form you confirm that you have checked with your child’s Health Care Provider that they are happy for you to travel on the dates you have provided.

Please add here anything else relevant for the booking process, for example if someone is using a wheelchair or requires step-free access:

REQUIRED INFORMATION (Please complete)

Whilst we will do our best to accommodate, we cannot guarantee your preference will be available.

Please select either Shorefield Park or Church Farm(Required)

Please list the names and ages of all guests staying at the cabin. Please note that the maximum of guests for Shorefield is 6 and for Church Farm 4. We also allow an extra child if under 2 years of age.

Guest 1 – Lead adult making the booking(Required)

Guest 2 – Name and age if child(Required)

Guest 3 – Name and age if child

Guest 4 – – Name and age if child

Guest 5 (if under 2 years)

Guest 5 – Name and age if child

Guest 6 – Name and age if child

Guest 7 (if under 2 years)

Church Farm

Are you taking a dog to Church Farm? (Please note we are unable to allow puppies, thank you)(Required)

Yes

Due to Park regulations in order to enter the Holiday Park we will need to pre-register your arrival in advance of your stay.

Estimated arrival time(Required)

Vehicle registration(Required)

You will be sent an email from Haven Customer Services with a registration code and a PDF car pass you will need to print this out and display it in your car window in order to enter & exit the park at the security gates. Your information will be protected by Haven’s privacy policy, you can read more about this here: privacy policy

CHURCH FARM – HOLIDAY CARAVAN TERMS AND CONDITIONS

Please take the time to read through our TERMS & CONDITIONS of the use of our holiday caravan. By signing, you indicate that you accept these terms & conditions and that you agree to abide by them. If you have any questions on these terms & conditions please email us at respite@momentumcharity.org. If you do not accept these terms & conditions, then a booking will not be approved.

Church Farm T&Cs(Required)

1) All persons under the age of 21 must be accompanied by an adult.
2) Only named people on your reservation form can occupy the caravan and anyone not listed may be asked to leave.
3) The number of persons permitted to stay in the caravan must not exceed that for which they are designed. Maximum occupancy is 4 persons for Mo’s Sunset Lagoon – caravan. There is space for 1 car next to the caravan.
4) The period of your stay is as follows: Arrival from 4pm and departure by 10 am. This is to allow for the cleaning schedule. Please collect your keys from the key safe outside the cabin. You will be given the code for the safe when you receive your Guest Letter, shortly before your stay. Please ensure that you replace the key in the safe & mix up the code before you leave.
5) Smoking is not permitted inside the holiday caravans or on the verandas. Anyone doing so may be asked to leave and will be refused any future bookings with Momentum.
6) Please do not move the BBQ and ensure that you clean it after use. Please store the outside cushions inside the cabin at the end of each day.
7) If any person acts unreasonably, causing damage to property or annoyance to other users of the park, they may be asked to leave the holiday caravan.
8) You are responsible for any damage caused in or to the holiday caravan. Momentum also reserves the right to enter the unit, or to appoint a third party to enter on behalf of the charity, under special circumstances or emergencies. Excessive noise levels will not be tolerated at any time and we ask that noise is kept to a minimum between 10pm and 9am.
9) Please look after our holiday caravans so that they may be enjoyed by all. Please report any accidental damage to Momentum immediately, so that we can arrange a repair or replacement.
10) The following are not allowed in the park: tents, gazebos, laundry lines, caravans, motor homes, powered scooters, Chinese lanterns, fireworks, kites, rollerblades, micro-scooters or drones.
11) If you child is currently in active treatment or receiving oxygen; by returning these Terms and Conditions you confirm that you have checked with your child’s Health Care Provider that they are happy for you to travel on the dates you have booked.

It has taken a lot of hard work and dedication by many people to enable Momentum to buy our holiday homes and therefore we ask you to respect a few house rules:

HOUSE RULES

1) Please – No outside shoes inside the cabin
2) There is NO SMOKING in the cabin or on the veranda
3) Please do not move the BBQ and ensure that you clean it after use.
4) Please store the outside cushions inside the cabin when not in use
5) UTILITIES – Please appreciate that Momentum Children’s Charity pays for all GAS, ELECTRICITY and WATER so please avoid unnecessary usage – running taps and leaving the heating on whilst the cabin is empty.
6) DOGS – one well behaved dog is permitted in the caravan but they must be kept off the furniture and out of the bedrooms at all times. Dogs in the park must be kept on the lead and cleaned up after. Dogs are welcome to walk on Pagham beach which we have direct access to. This is a dog-friendly beach and dogs can go out on the beach all year round.
7)RUBBISH – should be deposited in the dustbins located around the site. Re-cycling is encouraged, and each dustbin is marked clearly. Please dispose of all rubbish at the end of your stay.
8) FRIDGE AND FREEZER must be left completely empty on the day of your departure
9) BREAKAGES – Please report to Momentum Children’s Charity in order that we can arrange replacements or repairs
10) Please replace any cleaning products and consumables that you use, including washing up liquid and toilet paper
11) Be aware that this is a waterside location and children must be supervised at all times
12) Please ensure that all windows are closed and doors are locked when you leave the caravan
13) Please turn the heating down (not off!) when you leave
14) Please return the complimentary passes to the box in top drawer under the cooker hob
15) At the end of your stay please place any bed-linen used inside the striped laundry bags provided, for the cleaner to collect
16) Please ensure the key to the property is replaced and locked in the key safe when you leave on your final day

I confirm I have read the terms and conditions above, and I understand and agree to be bound to and to comply fully with the same.

I have read and agree to the T&Cs

Shorefield Park

In order to use the facilities at Shorefield, such as the pool, we will need to register your arrival and apply for a Park Pass on your behalf. You will not need to make any payment for these passes. If for any reason you are contacted by Shorefield reception for payment details, all you need to do is confirm that you are staying in a Momentum charity unit.

Vehicle registration(Required)

SHOREFIELD – HOLIDAY CABIN TERMS AND CONDITIONS

Terms and Conditions(Required)

1) All persons under the age of 21 must be accompanied by an adult.
2) Only named people on your reservation form can occupy the cabin and anyone not listed may be asked to leave.
3) The number of persons permitted to stay within the holiday cabin must not exceed that for which they are designed. Maximum occupancy is 6 persons for Mo’s Pebble Lodge, and 6 persons for Mo’s Keep (not including infants under two). Each cabin has space for parking 1-2 cars.
4) The period of your stay is as follows: Arrival from 4pm and departure by 10 am. This is to allow for the cleaning schedule. Please collect your keys from the key safe outside the cabin. You will be given the code for the safe when you receive your Guest Letter, shortly before your stay. Please ensure that you replace the key in the safe & scramble the code before you leave.
5) Smoking is not permitted inside the holiday cabins or on the verandas. Anyone doing so may be asked to leave and will be refused any future bookings with Momentum.
6) No pets are allowed in either of the holiday cabins, including dogs. If you are found to have brought a dog or any other pets with you, you will be asked to leave immediately.
7) If any person acts unreasonably, causing damage to property or annoyance to other users of the park, they may be asked to leave the holiday cabin.
8) You are responsible for any damage caused in or to the holiday cabin. Momentum also reserves the right to enter the unit, or to appoint a third party to enter on behalf of the charity, under special circumstances or emergencies. Excessive noise levels will not be tolerated at any time and we ask that noise is kept to a minimum between 10pm and 9am.
9) Please look after our holiday cabins so that they may be enjoyed by all. Please report any accidental damage to Momentum immediately, so that we can arrange a repair or replacement.
10) The following are not allowed in the park: tents, gazebos, laundry lines, cabins, motor homes, powered scooters, Chinese lanterns, fireworks, kites, rollerblades, micro-scooters or drones.
11) If you child is currently in active treatment or receiving oxygen; by returning these Terms and Conditions you confirm that you have checked with your child’s Health Care Provider that they are happy for you to travel on the dates you have booked.
12) Please note that if you are visiting our cabins during the winter months the decking areas can become slippery and icy, please ensure that you take extra care as we cannot be held responsible for any injuries that may occur.

It has taken a lot of hard work and dedication by many people to enable Momentum to buy our holiday cabins and therefore we ask you to respect a few house rules:

HOUSE RULES
1) No outside shoes inside the cabin please.
2) There is NO SMOKING in the cabin or on the veranda.
3) NO ANIMALS
4) UTILITIES – please appreciate that Momentum Children’s Charity pays for all GAS, ELECTRICITY and WATER so please avoid unnecessary usage – for example running taps unnecessarily and leaving the heating on whilst the cabin is empty.
5) RUBBISH – should be deposited in the dustbins located around the site. Re-cycling is encouraged, and each dustbin is marked clearly. Please ensure you dispose of your rubbish at the end of your stay.
6) FRIDGE AND FREEZER – must be left completely empty on the day of your departure.
7) BREAKAGES – please report to Momentum Children’s Charity in order that we can arrange replacements or repairs.
8) BBQ – please clean after use and replace the cover, please bring the outside cushions in.
9) Please replace any cleaning products and consumables that you use, including washing up liquid and toilet paper.
10) Please turn the heating down (not off!) when you leave.
11) Please return the keys to the key safe when you leave and scramble / mix up the code.

I confirm I have read the terms and conditions above, and I understand and agree to be bound to and to comply fully with the same.

I have read and agree to the T&Cs

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MOMENTUM RESPITE BREAK – CABIN BOOKING FORM

Booking Information

REQUIRED INFORMATION (Please complete)

Church Farm

CHURCH FARM – HOLIDAY CARAVAN TERMS AND CONDITIONS

Shorefield Park

SHOREFIELD – HOLIDAY CABIN TERMS AND CONDITIONS

Thank you for completing the booking form, we will be in contact shortly.