Booking form for Co-counselling Family Week at the Peak Centre 17th - 24th August 2018
Please complete a form for EACH adult. This is because people often have individual email addresses and (mobile) phone numbers.
Name *
Your answer
Email *
Your answer
Phone number *
Your answer
Gender *
Name of coco teacher *
Your answer
Date of fundamentals *
Your answer
Personal information
Children and young people
All places for children must be booked in advance.
Name of Child One
Your answer
Age of Child One on 17th August 2018
Your answer
Name of Child two
Your answer
Age of Child Two on 17th August 2018
Your answer
Name of Child Three
Your answer
Age of Child Three on 17th August 2018
Your answer
Food will be vegetarian. Please note that restricted diets are not guaranteed as we need to confirm that the caterer can meet your request.
Please indicate if you have restricted dietary needs.
Restricted diet details
Your answer
Below are the options available. We will do our best to accommodate your preferences, but we predict that there will be demand for the smaller rooms, so we may not be able to. If you want to be non residential, please contact us before completing this form as we will need to negotiate a charge with the centre.
Type of accommodation *
'Small room' accommodation will be used by the community in workshop times. Large dormitory rooms will not be used for workshops. The 'downstairs room' option is for people with disabilities who need to be close to the accessible shower and toilet.
Other accomodation requests
We will do our best to meet your your accommodation preferences but there are no guarantees
Your answer
Lift requested from
Your answer
Lift offered from
Your answer
Please indicate the appropriate fee level for your booking. *
Rates for children
Child (12 and under) £170
Teenagers (13 - 17 inclusive) £210
Child one
Child two
Child three
Total amount due *
Your answer
Deposit paid into bank *
Your answer
Name on payment *
If someone is paying on your behalf (for example, if you are booking as a couple or family) please tell us who is making the payment.
Your answer
Amount still to pay *
Your answer
Intended date of final payment *
Please set up you final payment now. If you do this there will be no need to complete an 'additional payments' form. If you wish to pay the balance in instalments please give details of amounts and payment dates in 'other information' below.
Your answer
I would like a bursary of...
We will confirm bursaries in June. We will do our best to meet your needs but the amount we can offer will depend on how much is requested overall and the amount of money in the bursary fund.
Your answer
Other information
Please use this space for any other information that you need to provide.
Your answer
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