Title Mr Mrs Miss Surname

Christian Name

Address Line 1

Address Line 2

Address Line 3

County

Post Code

Phone Number Day

Phone Number Evenings

Fax Number

Email Address

Accommodation Dates

Extras Required- Please Tick

Highchair - No Charge

Baby Cot - No Charge

Play pen for Gite and Pool area - No charge

Bedding Requirements

Large Downstairs Bedroom

Mezzanine Level

Bed Settee required in Living Area

If Cot required, please select in which room

Towel Requirements - Refundable Deposit Required for Towels @ €39/£20 Per Person Per Week - Payable on Arrival

Amount required For Gites @ €8/£5.00 Per Person Per Week

Amount required for Pool @ €8/£5.00 Per Person Per Week