Jonas Respites Referral Form
Jonas Respites provides peaceful holidays at a reduced cost for individuals and families with limited opportunity for respite from difficult circumstances.

Successful referrals are entitled to 50% off our standard cabin charges. A referral form must be completed on behalf of the applicant by a professional aware of the circumstances of the individual(s). Successful referrals are valid for a year from the date of acceptance, in which guests are welcome to visit on multiple occasions.

The Jonas Centre processes personal data in line with GDPR regulations.
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Referrer Name *
Referrer Email
 *
Referrer Telephone
 *
Referrer Organisation and Address
 *
Primary Guest Name
 *
Primary Guest Email
Primary Guest Telephone
Primary Guest Address
Other Guest Names:
Numbers of Adults (max 5 adults per cabin)
 *
Minimum
Maximum
Number of Children (max 4 children per cabin)
 *
Minimum
Maximum
Why do these guests need time away at a reduced cost?
 *
Who should we contact about the referral?
 *
Any other information?
Submit
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