Booking Details

Before you use this form, we suggest that you contact our administration department to to check that we have suitable accommodation available for the dates you require.

We also suggest you read the booking conditions now, as you'll be asked to confirm that you've read them at the end of this form.

Please complete as many details in this form as you can, then click the 'Send booking' button at the bottom of the form. You can change your entries at any time before you submit the form, or you can clear the whole form using the 'Start again' button.

If you feel that the options offered don't reflect your actual needs adequately, use the 'Any further comments' box to explain in more detail.

If you are booking for more than two guests, please complete and send this form as many times as necessary, remembering to change the appropriate details each time.

Contact details (These entries must be completed - they will be used to confirm the booking and clarify any details.)
Name:
Telephone:
Email:	(Enter 'none@no-email.com' if you don't have email)

Dates:
The minimum stay is two nights, the maximum is 21 nights.

Arrival date:
Departure date:

Have you made a provisional booking for this stay? No Yes

What do you hope to gain from your stay? (Check all that apply)

Physical rest	Time to think	Time to pray
Physical healing	Spiritual healing	Counselling
Spiritual direction	Respite from responsibilities	Fellowship
Holiday	New relationship with God	Don't know

Accommodation preferred:
All rooms have wash basins with hot and cold running water, and all non-ensuite rooms are close to bathrooms.

1st choice:

2nd choice:

If it is essential that you have a ground floor room, please indicate the reasons here:

Guest 1 details

Title: First name: Last name:

Address 1:
Address 2:
Town/City:		Postcode:
Telephone:		Email:

Age group: Will you be asking for counselling? No Yes

(We regret that we are unable to guarantee one-to-one time unless requested in
advance. No counselling is available at weekends or during special retreats)

Do you receive medication which helps to manage your emotional or psychological well-being? Yes No

(Note: For legal and insurance reasons, Green Pastures is unable to take guests who require nursing care, personal care, or supervision.)

Dietary requirements:

Please note that we cannot deal with special diets other than those listed. If you have other requirements, please discuss them with our catering staff. The meals at Green Pastures are prepared in a kitchen where nuts are used.

Are you a Friend of Green Pastures? No Yes

EMERGENCY CONTACT DETAILS

Name of contact:		Telephone:
Relationship:		Mobile:

Further information
(Please enter details of any special circumstances or requirements that you have.)

Guest 2 details

Title: First name: Last name:

Address 1:
Address 2:
Town/City:		Postcode:
Telephone:		Email:

Age group: Will you be asking for counselling? No Yes

(We regret that we are unable to guarantee one-to-one time unless requested in
advance. No counselling is available at weekends or during special retreats)

Do you receive medication which helps to manage your emotional or psychological well-being? Yes No

(Note: For legal and insurance reasons, Green Pastures is unable to take guests who require nursing care, personal care, or supervision.)

Dietary requirements:

Are you a Member of Green Pastures? No Yes

EMERGENCY CONTACT DETAILS

Name of contact:		Telephone:
Relationship:		Mobile:

Further information
(Please enter details of any special circumstances or requirements that you have.)

Declaration
I have read, understood, and agree to abide by the booking conditions: No Yes

To confirm this booking, I understand that I must send a non-returnable booking fee of £50 per person per week, or the full payment if the total cost of my stay is £150 or less.

Please post your cheque/postal order - made out to "Green Pastures" - to:

Green Pastures Christian Centre,
17 Burton Road,
Branksome Park,
Poole,
Dorset BH13 6DT

If you wish to pay by credit card please telephone 0845 230 2680 (local rate) or 01202 764776.