Connecting in 2022: ASNA Family respite weekend registration

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Please use this form to register for the ASNA family weekend taking place at the Thomas Centre, Covenham St Bartholomew, Louth, Lincolnshire, LN11 0PB. 6-8th May 2022. Please complete one form per person.

Email *

Name *

Postal Address *

Age if under 18 years old *

Please let us know if you have any disabilities *

Blind

Deaf

Severe learning disabilities

Autism

ADHD

Non of the above

Mobility Needs - Wheelchair user

Other:

Required

Please let us know what makes you happy (for under 18 years olds with disability only)

Telephone number (mobile)

What is your estimated time of arrival (after 4pm)? *

4pm

5pm

6pm

7.00pm

Other:

I agree to take the Lateral Flow Test 24 hours before arriving. *

Yes

Exempt

Other:

Are you able to wear a mask? *

Yes

Exempt

Other:

Do you have any allergies. If so please state below. *

We would love you to take part in the weekend in some way. We will have celebration evening on Saturday evening to celebrate 20 years. Please let us know what you would like to do.

Lead out in a game

Spoken word or poem presentation

Provide a craft activity

Providing a musical rendition during the program

Items for sale for ASNA auction or 20& Market (Please bring items for ASNA 20& Market)

Other:

Facilities: Swimming Pool, Outdoor walks and activities, outdoor sports area, gentle go carting and play area, beach close by and much more. Accomodation is self catering with basic refreshments on arrival. You are advised to make an online order from the local food store - Sainsbury - to arrive on the day you will be attending. ASNA volunteers will be around to receive your order if you will be late. We will take your order to your accommodation. Please let us know if you will be making an online order and whether you would like us to deliver the order to your accommodation if you will be arriving later. *

I will be making an online order from local superstore - Sainsburys

Please take my order to my accommodation as I will be arriving late

I will NOT be making an order

Other:

Required

Cost: £150 (£100 ASNA Members). £50 for children 4-18 yrs. Free to all children under 4 years old and children 0 -18 yrs with disabilities. Please make your payment by using one of the methods below. Please confirm the method you will be using. Use your name as reference for the bank transfer. Bank details - Name: ASNA Bank: Lloyds Bank Account Number: 03151450, Sort Code: 30 91 53 *

ASNA Bank Account transfer -

Cheque in the post

Credit Card payment

Other:

Required

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